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A Trip to Siviya

Yesterday (Sept 30, 2007) was Botswana's 41st Independence Day. Everyone was very excited to celebrate the history of their peaceful country. In 1966, the government of Botswana obtained independence from England. 41 years later, there seems to be much to celebrate, including a stable government, a growing economy (centered on the diamond industry), and an increasing response to the HIV/AIDS epidemic. In honor of the occasion, I visited Clearance's village called Siviya in northern Botswana, about an hour northeast of Francistown. She was very excited to show me her village and to introduce me to her family.

Our trip began early Saturday morning, when Clearance picked me up and we traveled to the bus station. She was surprised that the station was not packed of Gaborone residents on their way to their respective villages surrounding Francistown. There were several bus companies, and Clearance has opinions about all of them. One of them is apparently prone to accidents so she will never take that one, even if it is the only one at the station. It was a pretty uncomfortable 5-hour ride, the seats are tiny, but we were able to sit together. The bus stopped several times to pick people up, to let people go to the bathroom (sometimes right there on the road), and then we arrived in Francistown. Francistown is a big city like Gaborone. We ate lunch there and then went grocery shopping for her family. Her family lives about an hour from the city and they don't have transportation so they shop rarely. Then we took a cab from the grocery store to a place where combis (white minivans) pick us up and take us to the village. Unfortunately the combi we wanted had just left so we were stuck waiting for about 2 hours. Then the combi finally came again and we squeezed in, and it started driving on dirt roads. It dropped us off at the main road in her village, where I had the good fortune of meeting Clearance's mom, who is a typical Motswana woman. She stands very proudly and says little at first. The three of us carried the groceries to her house, which was about a 15 minute walk along a dirt road. Many of the people in Clearance's village speak three to four languages, including Kalanga, Ndebele, Setswana, and English. Clearance's mom balanced the groceries in a basket on her head, while Clearance and I struggled with the handles. Their yard has the main house with the bedrooms and living room, a latrine, a hut where the cooking occurs over an open fire, and another house where clearance's grandmother stays. I was introduced to Clearance's father, paternal grandmother, younger sister, and cousin. They all welcomed me and made us dinner, which consisted of chicken and maize meal. Then we sat around and watched tv, but Clearance and I were so tired from the trip that we went to bed at 8 pm.

The next morning, Clearance's cousin made me tea and gave me slices of bread for breakfast. I showered, which means I sat in a big empty tub and used another small tub of warm water to wash. We then went to the courthouse where they celebrate Independence day, and everyone called me a white woman. Apparently there's 3 types of people - black, colored (mix of black and white), and white. So if you're not black or colored then you are white. I was introduced to the chief of the village. The chiefs achieve their positions through inheritance: if you are the first-born of a chief, then you inherit the position. There are now female chiefs, including in Ramotswa. The celebrations were very nice, there were speeches and singing and dancing. One matron read aloud the speech recited by President Festus Mogae. Then they served us food. They had killed a goat and cooked the meat right there. It was funny because Clearance wanted us to take the food and bring it back to her house to her mother and her grandmother. I realized, however, that the people there would have liked for me to eat the food they made, and I was hungry anyway. So I stood on line and then ate with my hands, and everyone was so happy. The food was wonderful! We then returned to her house, where there was more food. I really enjoyed watching Clearance's cousin cook, because she did everything over an open fire.

On our last morning, I woke up to Clearance's mom and sister sweeping their yard. I started sweeping with them, and everyone just stopped and watched. Clearance's mom said I was a very nice lady, because every time I was given food I said "thank you very much" and every time I started to eat something (a banana, peanuts), I always offered it to others first. She liked that I ate whatever they were eating and didn't complain. We then left for Gaborone, and endured a long bus ride. It was a wonderful trip, and I am excited to return to the village soon.


For more pictures with captions, feel free to check out the set "Trip to Siviya" on my account with flickr.com.

Hello, Botswana

Hi everyone, thanks for taking a look at my first blog entry. I’ve never had a blog before, but I have realized that there will be so many experiences to share during this next year. But I still love writing and receiving personalized emails, so no worries, I’ll keep sending those too.

I have returned to Gaborone, Botswana for a year of clinical research. I decided to take a year off between my 3rd and 4th year of medical school, so I could reexplore Botswana and participate in exciting research. I spent a few months in Botswana in 2005 working at the Botswana-Harvard AIDS Institute Partnership, and helped start an important study, the Mma Bana Study, on the prevention of mother-to-child transmission of HIV through breastfeeding. Now I’m back, and even have funding through the Doris Duke International Clinical Research Fellowship, a pilot fellowship that offers international research opportunities for medical students. I feel so grateful to have received the fellowship, as the summer events have proved useful and the mentors (particularly my mentor, Dr. Roger Shapiro) have been incredible.

Roger and I designed a study to determine whether there is an association between HIV infection, antiretroviral therapy, and adverse pregnancy outcomes, including stillbirths, premature delivery, and early neonatal mortality. Research studies have shown that HIV infection is associated with poor outcomes; however, it is unclear whether antiretroviral therapy is further associated with these outcomes. This becomes an important issue, as more HIV-infected women are gaining access to antiretroviral therapy during pregnancy, both for their own health and for the prevention of mother-to-child transmission of HIV. Thus, Roger and I plan to create a large database that documents every birth that occurs at Princess Marina Hospital in Gaborone, Botswana; the Gaborone City Council Maternity Wards in Gaborone, Botswana; and the Scottish Livingstone Hospital in Molepolole, Botswana. We will then determine which risk factors are associated with adverse pregnancy outcomes. We submitted IRB applications over the summer to the Botswana Ministry of Health, Harvard Medical School, and Harvard School of Public Health, and are hoping to have final approval in the next week.

Last week was very exciting, as Roger and I introduced the study to the physicians and nurses that run the maternity ward at Princess Marina Hospital. The physicians and nurses gave valuable input, including broadening the term loss of pregnancy and including all pregnant women who deliver after 16 weeks. Respect for the hierarchy is very important; even among the nurses, there are deputy nurses who run the wards and department nurses who oversee the work of the deputy nurses. The success of my work will largely depend on the cooperation of the nurses and physicians in these wards.

My housing is temporary at the moment. I am staying in a house close to to Princess Marina Hospital. There are 4 other expats living here, 3 of whom work at Botswana-Harvard as well. There’s Rebeca, an ID physician; Rim, a UCSD med student; Lindsey, who just graduated from Princeton and is about to start Mt Sinai med school; and Sarah, who works at the UN. Lindsey cracks me up the most! She just purchased a car and has learned to drive manual on the left side of the road.

I have 2 friends here in Gaborone from my stay here 2 years ago - Clearance, a lovely Motswana who I met at Botswana-Harvard, and Fajad, a nice guy who I met through a Harvard grad. They were both excited to see me again, which was so nice. Clearance is a very loyal friend - I decided to run a 10K race a week after I arrived, and she was there to cheer me on! It was really difficult, I think because the altitude is higher and the air is so dry. Also the race started at 2:30 pm in the afternoon, and the sun was most unforgiving. It was fun, and I am excited to start training for a half marathon at the end of October.

The same day as the 10K, I organized a braii for Clearance, since she turned 26 the day after I arrived! A braii is a barbecue, and staple foods include meat (on the bone), pop (maize meal), and chakalaka (relish and vegetables). Clearance’s friends and a group of friends my roommate and I met the week before came to the braii. The braii was a success! We stayed up all night and enjoyed the sun rise the next day.

One thing I forgot to mention was that during the 10K run, there were a lot of young girls who ran either barefoot or with socks only. Clearance mentioned that not everyone could afford running shoes, and that if they were going to run without shoes, she thought it was better to run barefoot rather than with socks. The pavement was extremely hot that day, and I cannot imagine how difficult it was to run without shoes.

That’s it for now! Thanks for reading!