A farm in Africa....

Madikwe is former farmland in South Africa just over the border of Botswana that more than 20 years ago was turned into a reserve for scores of wild animal species. These were imported and allowed to thrive in a natural environment. Tau is a game lodge that was created about 15 years ago, offering deluxe accomodations, excellent food, and access to the wild things by foot and by Toyota Land-Cruiser game drives. We left Gaborone on Friday afternoon, and arrived in Madikwe in time for the afternoon game drive. Our guide, Brad, was a 31 year-old South African (originally from Zimbabwe), who was a terrific naturalist. He knew the plants, birds, animals, geology, back-road pathways, and how to relate to 2 Mainers full of questions and 5 fun-loving Dutch 20-somethings who giggled most of the way around the reserve.
We encountered a broad range of animals, and were able to observe them up close. Brad was excellent at approaching the animals without spooking them or causing them to flee. We mingled with herds of elephants, lions mating and hunting wildebeest, giraffes, zebras, white rhinos, all sorts of antelope-type creatures, leopard, wart-hog, and birds of all types and sizes. Most of our pictures will be posted on Flickr.
We had a memorable weekend, full of beauty, adventure, and education. We are eager to have additional exposure to the African wild over the next few months!

Procedure Day and Setswana Lessons

Busy day, medical-wise. Morning report stimulated a spirited discussion about the inability to obtain desired radiographic studies (contrast CT) on patients admitted from A&E (the ER) with neurologic presentations. The passion of the house-officers was reassuring, and the understanding that testing needs to be considered in the context of clinical assessment essential to their development.
Medically, the day was eventful.
I consulted on a young 15 yo student with dramatic episodes of chest pain and fainting. She had a case of pseudo-syncope, in my opinion, and I urged reassurance and opposed sending her on to RSA for EP studies and possible pacemaker!
A 30 y.o. male patient with AIDs and TB was admitted with severe shortness of breath and weakness. His chest xray showed a massively enlarged cardiac sillouette, and he almost certainly had TB pericarditis. I did an echo, confirmed a huge pericardial effusion (5 cm in depth!) and arranged to do an echo-guided pericardiocentesis in the afternoon after my Chest Pain lecture to the interns. We drained over 500 ml of fluid, and I left the catheter in overnight to see if more would drain. I had obtained a sterile procedure tray from the OR and did the procedure aseptically, in part to demonstrate how this could be done even in the ward procedure room. The echo machines I have been using have been an immeasurable benefit, and I am grateful for all the patient mentoring given me by the echo techs at MMC while I prepared for this experience.

Barbara's Turn:
Thanks to the patient mentoring of Alima, who works here at the house on Pilane Court, I have been working on my Setswana. We have moved on from the dumela mma, rra greetings to goodbyes (different if you are the one leaving or staying behind) and now I am being drilled on how to say things like "I want to go to the store" or ke botta goya ko di shopong. All g's sound like back of the throat "H"s and there are frequently this "ng" which has a kind of n and click. They laugh hilariously at my efforts but it is fun and I hope to be able to talk maybe like a 2 y.o. by the time I leave.

While Setswana is spoken by everyone, there are also tribal languages which are the first language for many people and are completely different from Setswana, which means a lot of people are fluent in 3 languages here. English is taught in the school so everyone speaks it, but it is sometimes difficult to make out all the words.

Off to RSA tomorrow. More about that later.

Hospital Issues

This morning started promisingly. I did a consult on one of the nurses' father (a 70 yo man with hypertensive heart disease). She brought him to the hospital with records in hand for me to review and provide input. She even brought Xrays. I examined him, did an echo, and gave her the advice she needed to improve his care. I did 2 other studies with the Philips machine which will be great as long as I get an ECG cable. I'm waiting for it to be shipped.

A 28 yo woman who presented in heart failure (requiring mechanical ventillation) 2 wks after delivery had a classic post-partum cardiomyopathy, with poor systolic function on echo. I made suggestions regarding drug therapy in a breast-feeding patient. I encouraged her to feel optimistic about her ultimate outcome, and counselled the housestaff on safe and effective drug therapy.

I observed a chest tube insertion in a man with a pyogenic pleural effusion. I walked in on the procedure, which was going on for an hour when I arrived. The MO doing the chest tube had gloves on, but, dressed in her white coat, had her hand bag draped over her shoulder while she was trying to insert the tube. We will need to discuss aseptic technique with the housestaff. This, and the unavailability of hand-washing resources, will be a subject for discussion, to be sure.

I walked back to the flat to get into the pool and read a bit. Barbara was off making legal connections (see her input below or later).

For my echo buddies: the 2 machines I have access to, the Philips HD11 and the GE Vivid S6, are both excellent and allow me to make a real contribution based on objective data supplementing clinical observatons. Both machines function very well, and the Philips even has an XCelera report module! I'm still learning the buttons and the controls to help optimize imaging in the "TLS" patients.

Now for Barbara and the legal beat!

Today I spent a few hours at the office of BONELA - an advocacy group dedicated to combating HIV/AID discrimination and advocating human rights policy in Botswana. I met with a very energetic and young group of legal and community staff and will likely volunteer there a few days a week. There is not much in the law that protects people with AIDS from all kinds of discrimination in employment, housing, health care. They were very enthusiastic about my coming in and I hope to be able to contribute to their efforts.

The sun is setting now, and the birds are singing (or sqwacking), and dinner awaits us.

Barbara speaks!

Dear BB Blog readers,
Some of you may have been wondering after reading days of medical marvels from PKS tours of the Princess Marina Hospital, I wonder what happened to Barbara? Well, I am here and well but a little consumed until today with finishing off some reports from work back home so I was happy to turn the mike over to Peter who has been much more out and about each day than I.

Here are some of my first impressions of Gabarone and Botswana:

We are in rainy season (there is a reason they call their money "pula" the Setswana word for rain) - today the sky opened up and it rains really hard. People want the rain so they can grow their crops.

While English is the official language, everyone speaks Setswana (any of your #1 Ladies Detective Agency fans are acquainted with the greeting "dumela maa/raa" which actually everyone says. Greeting are very important, even passing people on the street. I am working on adding one vocabulary word /day. The "g" sound is pronounced kind of like a Hebrew "ch" People seem to appreciate my tentative efforts.

I see grown men hold hands in the street which is just a friendly thing to do and shaking hands involves a number of moves which I don't quite have done yet - shake hands for what seems like a long time, grab the thumb and also cross your hand over your chest.

Just about everything is available here in the stores but I think most of the export is consumed by the expat crowd which is pretty large - Penn, Harvard, Baylor all have quite a few people here.

Botswana time runs on a whole other schedule than our custom. It's hot so nobody moves fast and everything takes a while, so a certain person I know has had to readjust her clock a bit.

My greatest adventures so far have been riding the "combis' the little vans that are the local bus system. Everyone squeezes in and then most have to get out at each stop to let the departing passenger out - kind of like clown car. I am always the only white rider and I suspect the focus of some amusement, but what the heck - it is the cheapest and most interesting way to get around. We also have a taxi driver we use - he is from Zimbabwe and he is a great guy who we enjoy talking to. Lots of people come to Botswana from Zim looking for work often to no avail.

I am slowly being introduced to the human rights/legal advocacy crowd - a small but very dedicated group and I look forward to figuring out if I can contribute in any way. I have been asked to lecture at University of Botswana. Still no nothing about the legal system here, but I have 3 months to get up to speed!

Looks like Peter and I are off to South Africa this weekend, just across the border to a game preserve Madikwe that is supposed to be wonderful. Looking forward to it.

Hey, faithful readers, how about some comments? Would love to hear from you.

Summer in the City

Today was hot. I mean Arizona in July hot. Morning report was the usual 35 patients admitted over the weekend, and about 5 deaths. 80% of the patients are not rounded on on the weekends, as the team that is covering (1/5 of the MOs) round on only their own. I was asked to see several patients, one of whom I will never forget.

The first was a 90 year old demented woman who was in complete heart block. Her heart rate was in the 30s and she lay still as if dead. She would not respond to my efforts to speak to her or get her to react to tactile stimulation. My advice to the housestaff was to let her die in peace.

My ST elevation MI patient is coming along well on medical therapy. He has had no recurrent angina and is tolerating warfarin, aspirin, ACE inhibitors, and beta blockers well. I did an echo on him today and found that he had an LVEF of 45% with anteroapical and apical septal akinesis, but no observable mural thrombus. He had mild MR, and PA pressures were not high. I advised a stress test after discharge (we don't have a treadmill at PMH).

I was asked to see an unfortunate young man with right heart failure: elevated neck veins with a prominent V wave, tense hepatomegaly, and peripheral edema. He had marked prominence of P2, which made me suspect PA htn, but I was wrong....it turned out to be a tumor plop! The guy had a 66x33mm RA myxoma that obstucted RV inflow in diastole! The picture above may need a magnifying glass to see clearly. The patient comes from Zimbabwe, and the Botswana government won't pay for him to go to South Africa for surgery. He is really in a fix, and I feel powerless to help him. Hopefully the medical staff can figure out how to obtain the needed open heart surgery for him.

In the middle of the day, the director of the training program, a Montenegran named Gordana, took me to her nice home for lunch. I met her husband Branco (Croatian), who is a professor at the U of B. They have been here since the early 90s when the civil war in the Balkans drove them to seek the haven of a more peaceful environment here in Botswana. They raised their two children here, both learning careers in Europe, but both planning to return here to work.

I walked home in the heat over a dusty path with the 10-foot tall termite mound, amazed at how placid and reassuring life in Portland, Maine is. Too bad it's winter there.

All that jazz

We started the day getting some essentials at the Main Mall, where the 2 groceries were open for business. We sat around the pool reading and schmoozing with the medical residents. In the afternoon, the weekly jazz group played at the golf club on the covered veranda. They were actually quite good, and I was impressed how the keyboard player, Barry, my golf partner on Friday, sang like a Kentucky hillbilly despite his British accent when speaking. His wife, a spritely blond Scot, also sang with enthusiasm and gusto.

We walked back to the flat, and tried to BBQ steaks, but the grill is too deep for sufficient heat to reach the meat. I'll try Plan B another time. The South African wines are very good, plentiful, and inexpensive. We had a cab-shiraz blend that tasted great with the food tonight.

Saturday in Gaborone

We slept late and after breakfast walked to the nearby Main Mall ( we area definitely not in South Portland) where we walked along the stalls of people selling foodstuffs, leather goods, baskets, CDs, clothing, fabrics, and artwork. I was not interested in the fried caterpillers, which were considered a delicacy by the maternal-looking (traditionally proportioned) saleslady.

In the afternoon, we visited Dr. Baz Semo, an Ethiopian woman with an MPH from Harvard who works as head of the U.Washington HIV infrastucture work here in Botswana. Her sister, Maedot, is a dentist in NJ. Maedot lived with us in Portland in the early 90s when she was a student at Wayneflete. Baz shares Maedot's features, is a lovely person, and we quickly established a warm friendship based on common memories and relationships. We gave her a small bottle of Maine maple syrup, which we know she will love.

The evening was spent with the medical students and residents at a "brai" (barbeque) at the ICC flats, which make our place look tiny. Our only advantage is that we have A/C. The host, Dave Carr, is from Ohio and shares the pride of a Buckeye victory in the Rose Bowl.

Summer is here

After the steady rain of yesterday, today was cloudy, turning to sunshine by afternoon. The hospital activities involved one 20 year old male who had SVC syndrome, which on echo I found was due to a mediastinal mass pressing on the left side of his heart. His LA was basically a slit. The tumor was >10 cm by echo. Another patient, 58 years old (looked 70) was thought to have heart failure, but I proved he had no important heart disease or likelihood of hf.

The hospital is complex and loaded with staff. What's missing is management. I am struck by the absence of soap for handwashing at the ubiquitos sinks on the wards, and that nearly all the paper towel dispensers are empty. I needed alcohol to wipe down the echo probe between patients and this could not be located. The only explanation I can think of is the lack of anticipation of supply needs based on use projections.

This afternoon, I played golf with 3 locals who are missing their fourth for a while (on a trip). The course is quite nice and pretty well maintained. The greens are interesting, contoured, and stimp at ~8. Ant holes turn up, with little mounds of red earth, and it is permitted to move your ball to avoid this unexpected and unwelcome hazard on the greens. The birdlife on the course was very impressive, with beautiful specimens No snakes or bugs to speak of.

An interesting custom is to stop after 9 holes and sit down for lunch! I had eaten already, so I just had my customary banana, but one of the men had beef and rice and another poached eggs on toast!

Barbara took a break from work today and went off the University of Botswana to meet with a law professor Rekha Kumar who teaces human rights law and is very interested in developing a course on HIV/AIDs law (there is no law on AIDs on the books, only policy). She has asked me to lecture to her class which should be fun and work with her on some research. UB is a sprawling campus, lots of random buildings spread over a large area. The class she teaches are tremendous - several hundred students with no TA or any help with marking etc. She will also introduce me to the faculty member who teaches health law which should be interesting.

Couldn't resist the Ethiopian buffet tonight at the local mall - fairly pricey for Botswana but quite tasty.

Echo Wonderland

It rained all night and poured constantly until 2PM. The hospital corridors are all covered and one can stay sort of dry, if you step carefully. Now that the doctors and staff are aware that Penn has provided a cardiologist, the floodgates quickly opened. My first consult today was a patient who had been admitted as probable gastroenteritis. However, his week-long symptoms were very concerning and the admission ECG was misinterpreted by the admitting team -- it was a classic heart attack (anteroapical STEMI). We had to turn around the inital medical approach and get him treated properly. I echoed the young woman I saw yesterday with the dramatic examination and indeed she did have rheumatic heart disease, not a VSD. She had torrential MR and TR, severe PA hypertension, mild AR, huge atria, and LV systolic dysfunction. I have never experienced a patient with a palpable thrill (grade 4/6 systolic murmurs) due to MR and TR. What an eye-opener! I did several consults and 4 echoes today, all on a GE Vivid S6 machine on which I have to learn what buttons to push.

I gave an ECG talk to the residents today, well received. It's a challenge speaking to so disparate a group as African medical officers and Penn students and residents. They all were politely appreciative.

Barbara has been working hard on her Muskie projects, and has made contact with a faculty member at the law school. Also, the young Ethiopian woman who attended Wayneflete in the 90s who stayed a semester with us has a sister here who works in research for WashU. We'll see her next wk.

I am taking 1/2 day off tomorrow...the links are calling!

Cardiology on Steroids!

It cleared this AM after a steady rain all night (T-storms all afternoon yesterday). I walked to the hospital along a route that avoided the flooded customary pathways I usually took. After morning report, I was dropped at the Health Ministry, where in less than an hour and 30 Pula (~$4) I was an official doctor. I was asked to consult on 3 patients today. One, a 28 year-old woman was thought to have rheumatic heart disease, but her presentation and exam suggested congenital heart disease with advanced heart failure. The exam was dramatic, unlike anything we would encounter in the US.
A second consult was a pathetic 16 year old who looked 10-12 (cardiac cachexia). She had a dramatic exam also, more likely congenital disease than rheumatic. I got word from the Philips distributor that the HD11 will be delivered tomorrow, and we'll get a look at the cardiac anatomy and physiology by echo once the machine is in place.
The GE machine available to me 2 afternoons/wk is workable, but until I can find out the password to store studies and obtain an ECG cable to track rhythm, the studies will be less than optimal. I'm in contact with GE to learn how to reset.
The 3rd patient came to "A&E" (the ER) with severe bradycardia and 2:1 heart block. He was a vigorous 80 year old man with 2 grown concerned daughters. He will need to go to Johannesburg for a dual chamber pacemaker. The presence of a cardiologist here now will help the local physicians make better choices about who to agressively manage heart-wise. I have a Penn med student working with me this week, and it has been great fun.

Echo Frustrations

OK,this was an introduction to Bot-burocracy at its best. We met this AM after morning report, and in light of the huge backlog in echo needs, my usefuness in providing didactic lectures, and the need for me to freely consult, we agreed that an outpatient clinic presence was not possible to perform. Moreover, my time is limited to 3 months, so followup will be impossible. I'll consult on patients referred from the OPD but not primarily care for them in followup as I did in my practice. I befriended Matibine Matibine, the biomedical engineer who just returned from 5 years in the US (Drexel for training, and Boston for work....he never skied, but loved snowmobiling...wanted to know if I missed the New England winter...duh)
After morning report and a planning meeting this AM, I returned home to create an echo report to use for studies and retreive necessary items like 5kg echo gel, ECG electrodes, and the all-important bicycle cable lock.
I spent the afternoon in the OB clinic. This is where ulrasounds have been done in the past (obviously for OB needs, but because the same machine has been used for hearts, this is where, Tues and Thurs afternoons, I have the privilege of doing cardiac echoes. The time cannot be expanded, so I arranged to create a satellite echo lab in the male ward procedure room (all I need is a table, an electrical outlet, and a light switch). The room is a mess, and will take some doing to get cleaned up and acceptable to examine patients and do cardiac ultrasound.
This afternoon, the GE Vivd S6 was brought to the OB clinic from radiology. The plug was incompatable with the electrical system, which led to a prolonged recruitment of Matibine to make things happen. This included switching the plug to a Botswana-compatable connector, and changing the fuse in the plug when it wouldn't work. Finally, at after 4PM, I was ready to experiment with a totally unfamiliar echo system. The patient was rescheduled, so I imaged the next available person....me. I can make this system work OK, but will be happy to receive the Philips machine promised to me later this week. This will be the first time there will be availability 5 d/wk and actual reports!
We've had violent T-storms the past 2 days, but I'll take this over the daily snow falling in Maine this week.

First Day at the Hospital

I walked with another doctor from Penn (a pediatric AIDs specialist who arrived last night and is 32 wks pregnant, luggage lost) to PMH, which is a conglomerate of one-storey buildings that house the patients and support services. I was directed to Morning Report, which reviewed the admissions of >35 patients from the weekend. The illnesses ranged from crytococcal meningitis to overwhelming TB(I saw an XRay with total RUL atelectasis and miliary disease throughout the rest of the lung fields). An older woman with poorly controlled htn was discussed; the drugs and compliance are limited. A chest pain patient with an XRay suggestive of pericardial effusion was presented, but the analysis by the resident failed to consider this possible diagnosis. I am not yet certified by the government of Botswana to practice, so I didn't say much, especially since I hadn't been introduced to the group.
The echo situation is ripe for improvement. The hospital has recently acquired a new compact GE model that I'll have to work with to learn how to operate. It has a TEE probe, and there may be the opportunity to introduce TEE to a community on 2 continents! The Philips distributor called with the good news that the HD11 will be arriving tomorrow, and we'll take delivery Wednesday. Great news.
Indian food tonight.

Golf Possibilities

This is for my golfing buddies. We were invited to attend a "Jazz Brunch" at the Gaborone CC by one of the musically inclined doctors at PMH, Matt Dasco. We assumed that brunch was at the usual time, so we walked the 20 minutes to Gaborone CC at noon, only to find out that the "brunch" was scheduled for 3PM. We walked around, inspected the weight room at the Gaborone Sun Hotel (not worth the expense), and then had lunch, nicely served by a friendly young waitress. I chatted up the proshop attendant. There is an active membership, with tournaments every Saturday AM. Handicaps and scores are posted on the bulletin board, and club champions (both male and female) are memorialized on a painted board going back more than 30 years. There are caddies (50Pula for 9 holes, 100P for 18) (there are ~6.7 P/$). Club rentals are available. I asked "what kind of clubs do you rent" and he answered, "regular clubs!". From the look of the 2nd hand clubs for sale, I assume the available equipment is marginal at best. I brought with me 9 balls, tees, and a golf glove, and intend to play at least 9 holes sometime this week. There is a more upscale course 15k north of here, Phakalane, which I'll inspect later on.
We took a Combi back to the Main Mall (ironic similarity, don't you think?), and walked home, spending part of the afternoon in the pool cooling off.

Mokolodi Game Drive

"Mokolodi, a compact game park just a short distance outside Gaborone, can provide more than a glimpse of the bush and the game that frequents it.
"I went with Puso Kirby, the son of the park's founder, to let a bag of snakes loose in the wild. We walked along game paths, with Puso reeling off the names of the indigenous plants and their medicinal properties as we passed them. Then he opened the neck of his bag and casually took out a large cobra and a puff adder, putting them down on the ground and watching them move away into the undergrowth. Puso was born in this country, to white parents who came to Botswana from Zimbabwe. He could never live anywhere else, I suspect, because like just about everyone else I have met who has spent time in this country, he finds it impossible to be indifferent to it. Here was a man who was obviously in love with the place in which he lived."
Beguiled by Botswana By Alexander McCall Smith, NY Times Published: November 16, 2003

Peter and I decided to scout out the new neighborhood this a.m. and came upon a little Sat a.m. food and craft market only a few blocks from the house - right up my alley. We then walked to see the hospital and check out Peter's commute (probably a 10 minute walk). The sun and humidity is pretty intense (for Barbara anyway) and all the ladies use their umbrellas for the sun, but so far not much rain for the rainy season. After lunch we called our new favorite taxi driver, a man from Zimbabwe named Tendai (which means thanks in Setswana) who drove us about 10 miles out of town to a nature preserve called Mokolodi. This is a large sanctuary which provides a lot of nature and wildlife education - think Audubon in Botswana. We thought this would be a great first initiation to game drives before we head out for the safaris. We went out for about 2 hours in an open air truck and saw a surprising amount of game for a hot afternoon - probably not an ideal time for animal viewing - giraffes, zebras, cheetah, elephant, warthogs, wildebeast, impala, ostrich streched out over about 13,000 acres. Alas no crocodiles or hippos today - probably too warm. It was a great first look and also a great first workout for the binocs, camer and Flip camcorder - one of my favorite toys - thanks again Barbara T!

Day One

Our driver picked us up at 0815h. We had been awake for an hour and it felt like the middle of the night. K. drove us to the BUP headquarters (1 block away from our flat in Pilane Court), where we met Gill Jones, the administrator of the program and the mother of Nikki Jones, who directs the residents and students in their stay here. Gill is about our age and is the daughter of a missionary. She was raised north of here initially, and moved to the nascent community of Gaborone in 1954. She went to school in the UK, became a nurse, and has lived here after that, raising a family. Like many UKers, her family connections are world-wide, with a daughter and grandchild here in Botswana, and a son in Dubai, about to relocate (with wife and 5 children) to Australia!
Gill briefed us (again) about the program and helped me complete the governmental forms permitting me to deliver health care in this country. We then proceeded on Independence Ave. to the police department, where I had to have an officer document I am who I say I am, stamp and sign in several locations on the multiple forms, and then have to explain ("because you are a professor!) the origin of earthquakes (Haiti is much in the news) and the reason for hurricaines (idle curiosity, I think). He also tried to steal my pen, but since I had the last use of it, it went into my pocket thereafter.
We were driven downtown through the government center (flashy high-rise buildings) to the Ministry of Health. The picture is actually the dept of the Attorney General, but I couldn't take more because a security guard said it's illegal to take photos of public buildings. We rode an Otis elevator to 7th floor, where I delivered the paper work to a very quiet-speaking apparently insouciant young woman (it turns out that this is a cultural characteristic), who told me to return at noon next Wednesday for final processing. I can start showing up at Princess Marina Hospital on Monday, but I can't see patients until I am offically inscribed.
Koulong took us out to the Riverwalk Mall, where we had lunch and shopped for groceries. Once again, furtive photography was discouraged by a security guard ("the owner wants to pictures to be taken"). See attached anyway.
The groceries are Woolworths (high end vegetables and fruit) and Pick 'N Pay (meats and all other needs).
Back to BUP for a meeting with two of the Penn MDs where we discussed how I'll fit in over the next 3 months. I think it will be great, and am looking forward to the experience. I'm waiting to hear back from the echo distributor, and plan to set up the equipment at the beginning of the week.
Weekend plans will be discussed by my fellow blogster!

We've arrived!

After staying the night near JFK in a closet called "Best Western", we left very early in the AM for the airport by Hotel Van; instructed to get there 3 1/2 hrs before the flight was due to leave, we stood in line at SAS waiting for the agents to be ready to check people in. The process of security and other preliminaries was rapid, and much less intrusive than PWM, where I was treated like an opium king, being swabbed relentlessly. We were done by 0830h, with only 2 hrs to wait for our flight. The SAS flight was great, but long. The pilot kept emphasizing how long the trip was, trying to psych out the passengers. He succeeded. However, we had Ambien. However, it had no effect!!
The airport in JoBurg was fine, and there were no hangups. Lunch was very expensive, given the poor exchange rate given at the register for US$.
We were met at the airport by a lovely Motswana man who came from the same town as all the presidents of the country. I started calling him Mr. President, to his amusement.
The Pilane Court, where we are housed, is ideal for our needs. It is close to the hospital, has computers, WIFI, a pool, excellent faculty housing, and not too many inhabitants. There are 4 med students and 2 medical residents, all from Penn, upstairs. As usual, it's a small world. One of the residents, Kathryn, is the daughter of Rita Watson, a NJ cardiologist who was a resident when I was at Penn. More on this later, when her parents visit later this month.
Tomorrow is orientation, cell phone rental, contact with the Philips distributor, money changing, and food shopping. We are both well and happy and none the worse for wear after the excellent trip to this country.

Our Journey Starts Tomorrow!

Well, the preparatory lists are pretty well run through. Tomorrow, last-minute items both with the house and bank. We remembered to tell the credit card companies not to be alarmed at sudden billing from Botswana. We told the dry-cleaner to take a 3 month break. We have income tax preparation to do, but the 1099s will delay our getting everything to our accountant (also a reader of this journal!), so we'll do what we can by email and snail mail to get taxes in on time (we get back 4/15!)
I even had time to prepare another Power-Point talk, less boring than some of my previous opi in light of its relative brevity.
We hope to fully enjoy the next three months: the experience of another culture, the opportunity to teach and learn, the hope I have to make a step forward enhancing understanding of the role of cardiology and cardiac ultrasound in general patient diagnosis and management, the opportunity to travel within the country and to RSA to see the countryside and observe the wildlife, and the environments of the Kalahari, the Okavango delta, Victoria Falls, Chobe, Capetown, and those two golf courses in Gaborone! I'm not expecting much cuisine-wise, but you never know.

LL Bean is a great resource!

We had some last-minute things to get from our place on Orr's Island, including one of the binoculars we use on the boat that has an image-stabilizer feature. I'm figuring at the distance we may be from the beasties, the amount of magnification may make image stabilization handy. I needed to replace my aged boat shoes (the universal footware), so we stopped at Bean's (shoes on sale) in Freeport. One of our duffle bags had lost a handle on one of Emily's soujourns to the Balkans, so we took it in and got a replacement gratis. This is a great service, and truly appreciated. In the sale bins by the front door were: mosquito netting and spray bug repellant, and later we picked up little book-reading lights (compact, LCD bulbs), all meant to enhance comfort on the plane and in the Penn Housing, which we are told have suboptimal reading light. Post-holiday shopping is great!
We are winding down to departure...lists still incompletely fulfilled, but we'll get there. We took a breather this afternoon and took in the HD version of the Met production of Der Rosenkavalier, which was very beautiful and energetically and artistically performed. The lists will be revisited tomorrow.

Last minute items

With one week to go, I keep churning out Power Point talks. I'm currently more than 1/2 way done with "Unstable Angina/Non-ST Elevation MI", which is a real dozer. This was requested of me, although I'm unsure how much CAD I'll run into. The modern therapy of MI often involves cardiac catheterization, and that requires a plane ride to Johannesburg! I think we'll take a conservative strategic approach when possible.
Last minute trips to hardware store, drug store, calls to Minimed,etc. We will go to Harpswell this weekend to make sure all is well, and pick up our image-stabilizing binoculars (bought for the boat), which should make game observation at a distance easier. Then we'll pack, trying to keep weight and bulk to a minimum. I'm reminded about all the chazerai Teddy Roosevelt's expedition took to "The River of Doubt", and recognize the advisability of minimalism!

Beat of Botswana

Dumela mma and rra, (that's hello, ladies and gents in Setswana)
Hey music lovers -
Here is a nice intro to music of Botswana, brought to you by the HBO Ladies Detective Agency production (you may want to check out the HBO LDA site which also has a nice 25 minute video portrait of Botswana.

http://www.youtube.com/watch?v=_jgaIl-6-ZE

Can't wait to hear these sounds live!
Go siame (goodbye)
Barbara and Peter

Happy 2010

Happy New Year all - It's about time to give my blogster companion a rest and update you all from the non-physician side of this expedition. Departure from Maine is a mere 11 days away. Peter and I are making our way through the voluminous lists of things to do, mark down, take, don't forget, etc. A big snow storm this weekend, the kind that make the weather folks salivate, is churning up - another reminder of what we are leaving behind as we head for the 90 degree summer in the southern hemisphere. I have been immersed in a lot of African reading, memoirs of life in Botswana, prior to independence, tales of the Kalahari, just trying to pick up the groove of the country. While I know most folks travel to Africa primarily to see the animal life, I am more interested right now in learning about culture and the people. I suspect in Gabarone we will initially be hanging out mostly with the Penn and ex-pat crowd, but I hope eventually to meet and get to know Batswana. Unlike Peter, my schedule in Botswana is somewhat fluid. I will continue to work on a few Muskie projects on telemedicine (very appropriate for distance management) and mental health advance directives, but I am hoping to make some contacts at the law school and with the NGOs to find some overlapping areas of interest in public health, family planning, health delivery systems. We will see what develops. I think much of the success of this trip for me is about embracing the opportunities that present themselves once we get there.
A delightful "small world" connection - we recently got back in touch with Maedot Semo, a wonderful Ethiopian young woman, who lived with us while she attended Waynflete. Maedot is all grown up - a dentist, married with 2 kids, who let us know about her older sister, a physician working on HIV/AIDs policy in Gabarone! Can't wait to meet her.
Peter and I are very excited about this adventure and can't wait to take you along with us!
Best wishes for peace, health and happiness in the new year.