Holy Week

The week has been very productive thus far, and today was no exception. I was shadowed by Diana Dickenson, MD, who runs the "Independence Ave. Surgery" and who has been a driving force in HIV/AIDS diagnosis, treatment, and prevention in this community. Every October, she helps organize an AIDS conference that is important in the ongoing fight against this infection which is robbing the country of most of an entire generation. She wanted to know what exactly I do here. We reviewed the recent TB pericarditis patient I tapped, and, after nearly 4L of drainage, the catheter is ready to pull out. I'll do a follow-up echo soon. She pointed out the characteristic rashes of moluscum contageosum and herpes simplex infections. The dermatology fellow was informed and will consult.
We rounded on the postoperative valve-replacement patients being treated for infective endocarditis (4 wks of IV antibiotics for each). Both are doing quite well, but one, with a Hickman central line, has had to get her drugs via a peripheral IV because of the nurses' reluctance to infuse medicines through this port.
In the afternoon, the chief of medicine asked me to assess her friend, a local lawyer with probable thrombophebitis of the right lower leg. This problem led his doctor to discontinue statins and substitute "red rice yeast" to lower cholesterol for fear that there was a relationship between the statin and the swollen leg. I ordered an ultrasound and will anticoagulate the patient if DVT is proven. He also will restart the statin.
The former PMH superintendant asked me to see 2 patients, one with a pulmonary, not cardiac problem, and another who had an abnormal ECG and hypertension; the meds for BP had been stopped by his pharmacist because he had become normotensive. I got him back on his antihypertensives.
I also was asked by the surgeons to do an echo on an elderly man with an abnormal chest XRay (a "mediastinal mass"), which turned out to be a >7 cm aortic arch aneurysm. The pathology here is astounding.
Tomorrow we go to Cape Town and the wine district for the Easter holiday. More on this to come.

Holiday Time!

Back to work. We had another patient with a huge pericardial effusion (probably 4L), which allowed another opportunity to teach a resident echo-guided techniques for tapping the fluid, almost certainly tuberculous. The residents are enthusiastic about learning to use their skills (all are excellent IV starters, blood drawers, para- and thoracentesis performers) to do this technique....much of the anxiety about where the needle and catheter are going is relieved with seeing the effusion and obvious entry point by direct echo imaging. I followed up by giving another of my Monday PM talks on pericardial disease and pathophysiology of tamponade. Pictured here are 4 of the 5 residents (I'm the pale one in the back) with whom I have enjoyed working over the past 2.5 months.
We spent the evening at Matt Dasco's house (he's Penn Internal Medicine Faculty, and his wife Premal is a Baylor-employed internist) celebrating Passover with Gaborone's most ecumenical seder (4 of 20 participants were Jewish!). All had a great time. Barbara's matzoh-ball soup and sponge cake were greatly enjoyed and Dayenu was a big hit!

Johannesburg and Pretoria

Our friends Gordana and Branco Cavric, asked us to go along with them this past weekend driving to Johannesburg and Pretoria. Gordana is the chief of medicine at PMH and her husband is an urban planning professor at U of Botswana. They like to drive there and visit "the big cities" and thought we'd like to come.
The drive to JoBurg is 4 hours (sometimes at 200 km/hr!). We stayed in the northern section called "Fourways" in a charming country house with 2 large Bull-boer dogs, a very needy cat, and a fish pond full of hungry Koi. After breakfast on Saturday we set off for the "Origins Museum" at a local university, which had excellent exhibits regarding prehistoric man in Southern Africa, and a great set of videos describing the life of the San, the south African bushmen who live throughout the region.
We travelled on the the "Old Fort", the prison on Constitution Hill which formerly housed criminals mixed with political prisoners, in a harsh and cruel setting, blacks and "colored" separated from whites, with major differences in food, treatment, and survival. The Constitutional Court is on the grounds of the demolished prison, a symbolic demonstration of the present erasing the past. Somehow, I think the laws may have changed, but personal behavior and attitudes are slow to evolve as quickly.
Johannesburg is a huge city, 5 million inhabitants, built on a collection of hills, with huge driving distances from section to section. The old downtown has moved to a new section surrounding "Mandella Center" (named after you-know-who) and the malls in this place are very high end and with few vacancies. In addition, I was struck by the never-ending cavalcade of auto dealerships, all premium models (BMW, Audi, Mercedes, Lexus, Ford, GM, Toyota, etc). The rich collection of commerce must speak for a prosperous economy.
Dinner Friday was at the "MonteCasino", a faux Italian mall and casino that was very reminiscent of Las Vegas and Epcot combined. Saturday night we went to "Sophia's", and homage to Sophia Loren, who combined Greek heritage with Italian panache and beauty. We discovered ostrich and gamesbock carpaccio at MonteCasino, and beef carpaccio at Sophias, while Branco drank grappa. I settled for Jack Daniel's.
Sunday included an art show and a drive to Pretoria, the national capital, a very manicured appearance and a somewhat smaller, more intimate feel than JoBurg had.
We drove home with a big sky full of thunderheads and scattered rain showers. The border crossing is cumbersome but generally benign. It was a great weekend and the Cavrics were wonderful to have put out such effort to help us experience nearby RSA.

Signs that it's time to go home

1. I have finally run out of antiperspirant and shaving gel on the same day. Trust me, never try to go to the local market on a Friday afternoon...it's packed! Trying to locate personal items in the crowded shelves at the corner Spar is a challenge. There are loads of body washes, body cremes, and even roll-on deodorant-antiperspirants, but no familiar brands. And no shave creme at either of the markets! I'll have to keep looking for this item.
2. Echo requests are coming in daily. It's time for an echo tech to be trained, and to establish a modern laboratory with the equipment currently available.
3. My car battery (9 years old) has died and the BMW won't start. I have made an appointment the day after we return for a new battery and 90,000 mile inspection, oil change, and other maintenance issues. I'll then splurge and get the car detailed.
4. We are in the process of selling our primary home in Portland, and may have to vacate in June, 6 weeks after coming back. This task seems enormous, considering the 27 years of contents to deal with!
5. The damage from a windstorm in Harpswell had to be dealt with. Our neighbor, Mark Lieberman, is taking charge of the downed trees, after our daughter and son-in-law, Emily and Leigh (with Duncan's help) took care of electricity, security, and supervision of driveway access to the T-Ledge house.
6. The Philips corp will be repossessing the echo machine they loaned me in 2 weeks, unless the hospital buys it, or Philips donates it to the hospital or UPenn. I hope it will stay, as the machine is easy to use and has many of the features of more modern machines.
7. The local liquor store is out of Tanqueray. I finished their supply over the past 2.5 months (It really wasn't that many bottles).
With all of this swirling in our brains, we feel drawn back home. Three months is a long time to spend away from family and familiar surroundings, no matter how interesting and exciting travel and immersion in foreign culture seems.
In the mean time, this weekend we will visit Pretoria and Johannesburg, RSA. Over Easter we will be in Cape Town and the Franschoek wine district. We'll be home 10 days later. It's time.

Cardiology is here to stay

I believe I have established a needed service here. The residents and practitioners from all over the hospital call and request consultative and echocardiographic services for their patients. Today, a patient from Lobatse was referred for an outpatient echo. A patient was sent from the outpatient clinic who had severe AR, severe MR, TR with evidence of moderately severe pulmonary hypertension who will need valve-replacement surgery. A patient with an ST-elevation MI airlifted to South Africa returned with a new stent and relief of post-infarction angina. An elderly man with complete heart block returned from the same hospital with a new pacemaker, and since cataracts were discovered, restored vision as a result of cataract extraction and lens implant. I am working with the echo companies to fund the 3 month training of an Xray technician to learn echocardiography, so a modern echo lab can be established here at Princess Marina Hospital. If this can happen, I will feel that I have made a difference here.

Okavango Delta

On Friday morning we departed for the Okavango Delta in NW Botswana. We once again flew to Maun, but because the delta is a flooded area with camps on scatttered dry spots, we had to take a puddle-jumper 6-seat single prop plane into our camp, called Pom-Pom (which means "soft place" in Setswana). We were welcomed by the staff, who stood in front of the entrance singing a lovely Setswana song of "Dumella". The lodge, like Makgadikgadi, consisted of a central open-air pavilion with several self-contained tents surrounding the main building. This place was up-scale, with "en-suite" bathroom and out-door shower contained within the protective stockade fence. We had electricity after dark, a luxury in remote Africa off the grid!
After arriving, we had the afternoon to "siesta". We then met our guide, Paul, and tracker, Dicks, who took us out on a game drive at 4pm. It was an exciting ride. We saw an ever increasing variety of birdlife, which thrived in the wetlands created by the Okavango River which flows from the northwest and essentially empties into the sands of the Kalahari. The water levels rise in the late "summer"; the water in front of our camp had increased in the past week to allow maccoro canoes to be launched right from our beach, rather than having to transport them 20 minutes away to the nearest site of water access. We came across leopard tracks and found the cat resting near a freshly killed and recently eated kudu, the site of which was given away by the buzzing of flies on the carcass. At sunset we stopped for drinks and a view of the beautiful skies of western Botswana. The guides were looking out for Barbara and me...white wine and Jack Daniels! Dinner back at the lodge was first-rate, with excellent food, great variety, and thoughtful selections.
The tent was quite comfortable, and I slept great. Barbara did a lot of reading.
The next morning, after a light breakfast, we climbed into maccoros, which are modern replicas of the traditional dugout canoes indigenous to this area. I sat in the bow, with Barbara in the middle, and Dicks stood in the stern poling (the water was less than 1m deep, and in the reeds was safe from both hippos and crocks). The trip, which lasted all morning, allowed observation of a rich display of birds and scenery. The afternoon game drive was notable for lots of wading birds (our first flamingos, yellow-billed storks, and spoonbills), wildebeest, zebra, giraffes, a rare elephant, impala, leechwe, kudu, and lions (watching a sleeping lion is a moderate thrill at best).
Sunday morning allowed us to go on a long walk with Paul, who was a font of information about animal tracks, plants, birds, animal behaviors, termite colonies (the hills were especiallly impressive in the Delta). He carried a loaded rifle, but we never felt in any danger.
We flew back to Maun, and then on to Gaborone. The weekend was restful, and a great getaway which provided a chance to experience another region of this beautiful place.

Lobatse

This morning I walked over to the UPenn office at 0630h to meet Mike Pendleton, MD, a FP from Oregon who, like me, grew to detest night call and came to Botswana to help teach in the Botswana-UPenn Partnership. Mike primarily performs medical outreach. The primary sites are Mochudi (where I went last week), Lobatse, and Kanye. Today was Lobatse, a town about 40 km southeast of Goborone. We arrived at the Althone Hospital (the oldest in Botswana, built around 1922), used initally as military barracks. We attended morning meeting, which began with a prayer (recited in quick-time English by someone in the back row). There was no song, much to my disappointment. Patients were presented by the nursing matron sitting at the front. The doctors took little part in the discussion, and the scrubs-clad woman next to me seemed more intent on working through her cell phone messages. Curiously, there was a land-line phone on the main desk, which rang several times during report. The phone was answered, and a discussion ensued which rivaled (and obscured) the simultaneously occuring medical discussion in the same room!
Thereafter I was directed to the male medical ward, where several patients with cardiologic issues were housed, 8 to a cubicle. There were some interesting questions (rhythm, heart failure, and physical findings) in a few patients, among several patients without heart disease. I was even asked to look at the right thigh of a 27 year old HIV and TB-infected man who had moderate sized papules (somewhat pustular) and its anterior aspect, with firm lymph nodes in the groin on the same side. I thought it likely was extrapulmonary TB, and encouraged aspirational samples from both the papules and the groin nodes. For a cardiologist with little TB or HIV experience, I was gratified when the other physicians agreed with my assessment.
I spent the rest of the time with Dr. Pedro, a general internist from Cuba in his mid-late 50s, on a 2 year contract with the country held by the Cuban government. Cuba won't allow family members to travel, so he, like the Cubans in Gaborone at PMH, must leave their spouses at home. This would not work for Barbara or me. Dr. Pedro had collected a number of consults for me to see in his office, one of whom will see me Tuesday at PMH for an echo.
Today is the intern match day, and the students here are anxious, despite already knowing that they all were matched somewhere. We find out specifics tonight, and will be helping to host a cookout for the students and residents tonight, also partially hosted by UPenn faculty. I'm certain there will be no long faces among the prospective house officers. Plenty of beer will be available for anesthesia.
Tomorrow, we're headed back to Maun, to be transported by bush plane to Pom Pom Camps in the Okavango Delta. We'll have plenty of details after the weekend.

Back in the Saddle

After returning from our safari weekend, we returned to Gaborone and hospital routine. The director of the Botswana-UPenn Partnership, Harvey Friedman, MD, the chief of Infectious Disease at the U. of P. hospital and research ID doctor has come for the week and we have had the opportunity to share space, memories, and philosophies over dinner and wine.
The work in the hospital has changed, in that my presence is no longer an anomaly, but I am depended upon to help refine diagnoses, direct management, and objectify with echo cardiologic issues and emergencies. In the past day I have sent a patient with an ST-elevation MI to Johannesburg for invasive management (this was in the absence of 2B3A infusions, IV heparin, IV nitroglycerin, clopidogrel, etc), diagnosed apical mural thrombi in an elderly woman with embolic infarction of a foot, and ruled out cardioembolic source in a young patient with a stroke. Once I am no longer here, these services are in danger of lapsing. I have 2 ideas to allow them to continue. One is to have the device providers underwrite the training of an Xray technician to become an echocardiography technician. He/she could return to PMH, establish an echo lab, using the GE machine (Vivid S6) and/or the Philips HD11 (if the company would sell it to the hospital for a good price). The doctors here could be trained through CME to learn to read studies provided by a competent echo technician. The second is to encourage 2nd or 3rd year cardiology fellows to come here for 6 week rotations; this would be especially beneficial for the noninvasive fellows. They would be busy and stimulated by the breadth and depth of the CV problems here. I would encourage either UPenn to sponsor this endeavor, or perhaps the American College of Cardiology to fund it, similar to the program created by the American Academy of Dermatology, who sends a fellow here every 6 weeks. I am waiting to hear back from the vendors with respect to my first idea. It could make a huge difference here.

Makgadikgadi

On Friday morning, we flew to Maun in northwest Botswana, the center of safari activity in the country. We were transported by Land Cruiser over paved and dirt roads to Meno A Kwena, a small safari lodge in the Makgadikgadi National Park near the pans (Nxai Pan [pronounced N-click-ai] and Makgadikgadi Pan, salt-sand flats that are remnants of the great lake that covered this territory thousands of years ago, now part of the great Kalahari desert. The lodge is on the Boteti river, which has had water for the past 3 years after 20 years of severe drought. As a result, the plant life is changing, and animal populations are migrating as they did decades ago.
The camp is quite primitive but all creature comforts are provided. We slept in a tent which was well bug-proofed, with mattresses, comforters, oil lamps, and water warmed by the sun. We had a flush toilet and an outdoor shower. We were steps away from the main lodge. Our tent was protected by vertically arrayed tree branches that kept critters away from our compound (we thought). There was even a rock-encircled "plunge-pool" which was a god-send for hot afternoons after safari.
The meals were served in a dining tent. We were the only guests this weekend, so it was just us, our guide (Max) and 2 volunteers for an NGO called "Water for Life" which helps support the camp. The food was great, prepared by two Botswana women who, before each meal, would announce the choices, and then proclaim, "Ladies first!"
The first day we spent getting settled, and then walking down to the "hiding place" set on a low ridge above the river, where we watched elephants bathe below us. After supper, we went to bed, and since the night was warm, we left the windows open , screens intact. At 2AM, we were awakened to hear loud munching and snorting just outside our right window. This went on for at least 30 minutes. It was an elephant grazing in the bushes on the perimeter of our stick-protected compound! Sleep was impossible. After dumping a ton of stool and eliminating gallons of urine, it moved on. Thereafter, the baritone dronings of a giant eagle owl filled the night air. P slept better than B.
The next day, we took an 11 hour game drive. The desert is still relatively green, and in early autumn, the grass is beginning to brown up. We saw tons of elephants, giraffes, many hippos, impala, kudu, and a huge variety of birds. We returned to camp after a fulfilling day.
Dinner was great (they had Jack Daniels!) and we went to bed with elephants and hippos dancing in our heads. Literally. The elephants were having a pool party in the river below us for most of the night, and were chased away by a bellowing hippopotamus at about 4am. P slept much better than B.
Sunday morning we took a walk with our guide Max down to the river ("Jesus! This is GOOD!" was Max's frequent refrain). We were armed only with an arrowhead on the end of a stick, but really were protected by Max's extensive knowledge and experience with the animals and understanding of how to react to their presence. We studied Cape Buffalo tracks, elephant leavings, zebra and wildebeest skeletons (lion leavings), plants, birds, and geology. It was a great morning-long lesson.We drove back to Maun after lunch and flew to Gaborone in the early evening. This was a great opportunity to see the geology and wildlife of a part of Botswana not frequently visited.

Beyond Gaborone

This was a busy day. I was picked up at 0640h by Matt Dasco, MD, one of the UPenn clinical faculty who has an important role both in hospital teaching at Princess Marina but also in outreach. Today was our outreach day, spent in Mochudi, about an hour north of here. We arrived at the Deborah Retief Memorial Hospital in time for morning meeting in the Willie Neethling Hall, a room the size of a large dining hall. We sat around a line of finely finished tables with inlay, the medical staff and nursing staff all meeting together at the beginning of the day. The woman next to me, a soprano, began a song with Christian motif and Setswana harmony, with all present joining in. Thereafter, she led the morning prayer. Once these were completed, the nursing matron read the previous day's report: how many patients were admitted, how many infants were delivered, and, in great detail, the details of a stillbirth ("macerated infant") which engendered a great deal of discussion, including suspicions by the physician in charge (a Ugandan with a great barotone voice and intuitive questions) that the baby was in trouble as much as 3 weeks before delivery. Thereafter Matt presented an excellent talk to the staff on HIV infection and bone loss.
A petient was brought to the OPD for me to examine, a young woman who I suspect had primary pulmonary hypertension. We made rounds on the female ward, doctors and nurses reviewing findings in concert. I was struck by the communal approach to patient care, much different than the somewhat strained relationship doctors and nurses appear to have at Princess Marina...they seem to exist in different orbits and intersect primarily through written communications in the patient's chart. The Mochudi hospital seemed to have its act together better than Marina, including the fact that the beds were numbered, so patients could be identified by bed number, as opposed to the Marina approach of calling out the patient's name within the cubicle (hoping the patient was awake or able to communicate back!)
This evening, we attended the Ladie's #1 Opera House (a local theater company in southeastern Gaborone founded by Alexander MacCall Smith). We dined outdoors on wart-hog stew (called "venison") and lasagna under the stars. Thereafter, we trooped into the production (about the size of the Waynflete auditorium): the only seats available were in the front row. We lucked out and sat up close! The performance was a depiction of the wildlife of the Makgadikgadi, the salt pans of the Kalahari 7 driving hours north of here. Five men danced, played inventive instruments, and imitated giraffes,flamingos, elephants, wart-hog, kudu, leopard, lion, hyenas, vultures, and the people of the Kalahari. We were greatly entertained and enthralled. The dancing and singing were excellent.
Coincidentally, we are traveling to the Kalahari this weekend, and will be staying in Makgadikgadi; we hear that at this point we hold the only reservations, and so should have the full attention of the staff and guides!

Historic Day

Today I performed the first transesopahageal echocardiogram ever in Botswana. A patient was sent from up country with an expanded ascending aorta, and I was asked to exclude the likelihood that it was due to an aortic dissection. The GE Vivid S6 machine that was left here by the CT surgeons from Mauritius (they did two valve replacements here at PMH prior to my arrival) had a TEE probe (both adult and pediatric!) waiting to be used, and when I got a call from a doctor up country for this indication, I responded. Once again, it was Little Red Hen syndrome. I had to find a place (the endoscopy "suite"), the meds (for sedation, prevention of excessive salivation, analgesia, and simple things like a tongue blade with topical anesthesia, the care of the probe (cidex cleaning and drying). Everything went fine, and the referring doctor was delighted to have the results (no dissection).
The day was busy and included consultation on a patient with heart failure, who had a spectacular cardiac examination and turned out to have a congenital heart problem called Tetrology of Fallot. I am getting jaded...I am almost expecting incredible pathology every time I am referred a patient for consultation!

Far away

It's not easy trying to remain in control for issues and problems that occur at home. Tonight, Barbara has been trying to communicate with colleagues at USM regarding research issues, and at the time of the intended phone meeting, Skype malfunctioned, and we had to rely on the cellular phone connection to allow communication. Not a happy moment.
I also had malfunctions at the hospital, where my Power Point lecture decided to stop working in the middle of a particularly beautiful example of pericardial tamponade. Oh well, such is the life of tech-dependent types hoping their technology continues to provide adequate support.
Medically, the day was as usual, impressive. I was asked to consult on a patient with fever and dyspnea who had precordial thrills and on echo had infective endocardiitis, a large arotic valve vegetation, a rupture of the interventricular septum, and severe aortic regurgitation. Just another day at Princess Marina.

Social Gaborone

I have been taking Friday afternoons off, and after consulting on another patient with peripartum cardiomyopathy in the morning, got in the pool for a brief swim after lunch. We were invited to a dinner at the home of the President and Vice Chancellor of the brand-new Botswana Institute of Science and Technology, K.K. Bento. We had met at the Wildebeest roast 2 weeks ago, and developed a cordial relationship. He was from Florida, had a doctorate in civil engineering, and had been engaged by the new university to help build the campus in a town 1/2 way to Francistown, the original home of the current national president. The administration is only now being assembled, before hiring a faculty. The dinner was in honor of the new CFO, who was a woman from Canada who had been in Qatar for the past decade, working for a branch of a college from Newfoundland. Parenthetically, there appears to be a trend in American universities establishing foreign outposts...Cornell Weill has a medical college in Dubai! We were struck by the willingness of expatriots to spend years, sometimes decades, in foreign lands where they represent a distinct minority. They form a social life there that is heavily, but not exclusively, foreign-born. This goes for people from elsewhere in Africa, also. While there are many people in need who are economic refugees and who come to Botswana from deprived locales like Zimbabwe, many come for other opportunities, mostly professional like the two faculty members profiled above. Today, in an open market, we met a young woman from Kenya selling west-African fabrics and wooden carvings; she said that people expect her to be able to communicate in Setswana, where the only common language they really share is English!

PMH Needs

We started the day reviewing a very interesting case of disseminated tuberculosis in morning report. The case had been a conundrum, and review of the data and autopsy findings were very elucidating.
I am working to advance echocardiography at Princess Marina Hospital. Not only am I doing an average of 4-5 echoes/day (thanks to MMC echo staff who diligently trained me) but the value of objective data in patient diagnosis and management has been exceptional. I talked with the equipment distributor for cardiac ultrasound and ECG monitoring, and I believe that the HD 11 machine I have been using could be acquired by the hospital for a very reasonable fee. I also have identified a radiography technician who is eager to become an echo tech, and hope that the electronics distributor will be willing to sponsor a 3-month training opportunity for her in South Africa. This would allow a permanent high-quality echo lab to be established at Princess Marina Hospital, which would raise the level of cardiology services here.
On the home-front, we're making plans to go to the Okavanga Delta next weekend, and are eager to see another face of Botswana, very different from the Chobe environment. This is a part of an inland waterway that floods each rainy season - the birds and wildlife are supposed to be fantastic. We will fly to Maun and then take another light plane into the camp. We are benefiting from being here during the "green season" when rates are somewhat lower and we qualify as "residents."

Half-way mark

It is hard to believe that we are about 1/2 way into this adventure. In many ways the time has flown by. We still have lots more we want to do and see in this corner of the world and will try mightily to fit it in before April 15 rolls around. Today seems like a good time to take stock of what we have learned so far, about ourselves, Botswana, travel, living outside the US, etc. So here is my list:
1.We have discovered birding! The birds of southern Africa are beautiful, easy to spot, very colorful and a wonderful way to look into the ecosystem. For many years I watched my sister and brother in law, Roberta and David, pursue birds all over the world and did not get their fascination. At first, I was looking at the birds here kind of as a proxy for my dear sister, but then the birding fever caught hold. We have purchased bird guides, make lists of what we see, and are always looking up. This is clearly a dangerous hobby for anyone with anal-compulsive, listmaking tendencies. Anyway, it is great fun and the colors of birds here are off the charts.
2.The world has shrunk; the world is vast. So how do you hold on to this contradiction. Clearly, all this technology connects everyone not matter where in the world they are. We talk,skype, and IM with family and friends. In many ways we do not feel far away. The NYT home page is still a click away! However, there is a huge divide once you step away from the IT and look around you at a piece of the world, particularly outside of Gabarone that is untouched by many of these advances and where people live in a manner that is very different than the west. In some ways the IT is kind of a tether to what is comfortable and reminds us of home. It has also made it possible for us to keep working and communicating with you all.
3.Setswana is a hard language! I felt a little better about my slow progress once I read that Setswana is one of the Bantu languages and this language group is unlike virtually any other language family in the world. The other extremely difficult language is that of the San people (bushman of the Kalahari) who are known for the language with all the clicks!
4. Greetings matter. I am reminded of this daily as I make my way around Gabarone. Most people greet you or respond to your greeting with a dummela mma/rra, followed up by a whole how are you doing exchange. This is all before you get to your question, request. Some of the young folks may not mind shortening it up, but it is quite rude to rush into a conversation without the niceties.
5.People are people, and relating to the people of southern Africa is easy and rewarding. Working with men and women from this part of the world is enjoyable. They have as much to teach us as we can for them.
So that's all the musings for today.

Victoria Falls

We were picked up on Monday a.m. in Kasane and driven across the border to Zimbabwe - just a short 1/2 hr. drive. We had heard lots of stories about Zimbabwe - the political situation remains unstable, their currency is worthless (everything is now in US dollars) and people are desperately looking for any opportunities for cash. Zimbabwe used to be known as the breadbasket of Africa, had wonderful health care and great parks. Everything has changed of course and the people we spoke with were very frustrated with the Mogabe leadership and delighted to have tourists visit their country. We were in Victoria Falls to see the falls and stay one night at the historic Victoria Falls Hotel, which overlooks the fall. This 100+ year old hotel is a tribute to the British colonial spirit. The art work, posters, furniture all speak to the good old days when the Empire ruled - a step back in time, but still kind of neat to see it still, all spit and polish, afternoon tea on the veranda overlooking these incredible falls, all the staff dressed up. Outside the hotel, a bit of a different story and we heard pleas from all sides - I could have traded my holey sneakers for all kinds of stuff and we were offered "trillions" of Zimbabwean dollars - a kind of worthless souvenir. We braved the curio market where the most aggressive sales pitches are made and managed to buy some textiles - batiks and handpainted wares that were nice and light! The falls were very impressive, made even more beautiful by a rainbow that appeared as we reached the viewing platform. The falls stretch between Zimbabwe and Zambia with several islands in the middle. The roar from the falls can be heard from far away and there is permanent cloud of rain/mist that stretches far in the air over the falls. Quite breathtaking. While the adrenalin junkies go out for bungee jumping, rafting down the Zambezi, and all kinds of wacky extreme sports, we opted for another pastime. Yes, Heidi, we did not let the opportunity fail to add one more country to Peter's golf list. We played 9 holes at Elephant Hills Golf Club in Vic Falls. A unique experience and also testimony of how things have fallen apart in this stylish place. We were the only players at this course, which is located at a large resort which was entirely empty. The course was in kind of rough shape, punctuated by interesting wild life, including waterbuck ( a large antelope), lots of warthogs, impala. In any case, we had a fun time and added a little bit to the Zim economy, particularly to the appreciation of 2 caddies who were very happy to get some work.
Back to home base Gabarone today. We took a small 19 seater plane and got great views of the salt pans, part of the Kalahari Desert Reserve, a site of a future trip for sure.

Chobe Safari

On Friday morning, February 26, we flew to Kasane, a town in Northeastern Botswana, at the entrance of the Chobe National Park. We stayed in the Chobe Safari Lodge, a lovely facility on the Chobe River, just outside the park entrance. We had a room overlooking a Vervet monkey playground, and the lodge was an old African-style structure with raw wood beams, huge thatched roof, large common dining area, swimming pool, and waterfront for boat landings. On Friday, we did nothing but rest...we needed a vacation. Saturday had a game drive in the morning that was notable mostly for another Land Cruiser getting stuck in the mud (and almost tipped over;our guide was able to rescue the passengers of the other vehicle (there were lions around, and they had to get off the stuck truck) and escape the muck without disturbing the predators. A river cruise in the afternoon (lots of animals and birds, but the trip was on a large boat with several families of young children who were not controlled by their parents, and made for a cacophanous trip that scared the animals, bothered the adult passengers, and frustrated the guide, who gave up 1/2 way into the cruise.
The next day, we decided to do it right. We hired the same naturalist to take the two of us out privately, and we had a fabulous morning, seeing a huge variety of birds, and getting to study hippos, crocks, elephants, and the whole environment quietly and in detail. The afternoon game drive was similarly better than the day before, with great variety and much more detailed discussion by the guide. There were many huge herds of elephants, stately giraffes, mean-looking Cape Buffalo, and hoards of impala. The baby elephants were especially playful and loaded with pretend bravado. We watched wart-hogs cavorting in a waterhole...a mother and 3 playful piglets. Little did they or we realize what was ahead. At the end of the drive, we came upon a female lion and 3 cubs munching on one of the young wart-hogs (not for young audiences....ask us about the details under separate cover!)
We enjoyed the Chobe Safari Lodge, and thought the accomodations and food were excellent. It was a little large for our taste, which will affect our choices for future wilderness experiences.