Holy Shit! I'm in Africa!

Well, folks, I made it Botswana! There's so much to describe about the past few days that it obviously won't fit into this single entry. But I will try and give a basic flavor of the place and fill in the blanks later on.

I left early, early Monday morning from the City of Brotherly Love, flew to Atlanta and then to Johannesburg, South Africa on a hellish, 17-hour cruise across the Atlantic (stopping briefly at Sal Island for refueling), followed by a puddle-jumper to Gaborone, Botswana, where I'll be staying for the next 5 weeks.

There's a ton of other Penn people here, all of whom are living in the same apartment complex, in fact the most that have ever been here at one time. There are two attendings (Drs. Kessler & Gluckman), 2 I.D. fellows (Svenja & Rose), five residents (myself, Jon, Kara, Matt, & Sameer--though Matt & Sameer had their last day today), and six medical students from Penn.

Every morning we wake up and meet in front of the flats at about 7:10pm, then take a 20 minute walk or so down some dirt paths to the Princess Marina Hospital. We're in charge of two medical wards (one male and one female). Jon & I flipped a coin & I ended up on the male side. The MMW (male medical ward) is comprised of 5 cubicles of 10 beds apiece--each cubicle is essentially a big room that all the patients share.

When I arrived, we had been ''on call'' the night before and had inherited a list of 16 patients. To give you an idea of how common HIV is here, 13 of the 16 patients had known HIV infection. Probably about 40% I would say had tuberculosis. In the U.S. when somebody with pulmonary T.B. gets hospitalized, they get thrown in a special negative pressure isolation room and anybody entering the room must wear a mask to prevent transmission. Here in Botswana there are no special precautions whatsoever, and I guess I'll just have to cross my fingers and hope I don't infected (thus far of the 40 or so Penn residents who have rotated for 5-6 weeks on this service, fortunately none of them has ever had their PPD come back positive).

People are admitted for stuff that's both common in the U.S. (asthma, diabetes, stroke) and also uncommon in the U.S. (disseminated T.B., malaria, all sorts of weird infections & cancers you get from AIDS). In general there are lots of procedures to be done--today, for example, our team did a total of 3 spinal taps, 1 thoracentesis (removing fluid from the lung), and 1 paracentesis (removing fluid from the belly)!

I'll try and post more later including some pictures. Not sure what I'm doing this weekend (we were going to go on a safari, but being that it's been the rainy season I've been told it may not be the best weekend to do this) but if I'm hanging around Gabs I should be able to catch up on my blogging...

Sending my regards back across the Atlantic,

Nate.