Fueled by Frustration in Africa

Mindy Licurse, MD

I will confess my venture into global health first began as a college student with the selfish hope to fulfill a childhood dream to go to Africa, with an idealistic naivety that I was about to change the world with a single visit.  I packed my bags full of limited medical supplies, lightweight clothes that could be rolled up to save room, plenty of bug spray, and hopped on the plane for a three week trip to Tanzania.  Before I left, I remember a friend distinctly saying, “That will be an eye-opening experience.”  I smiled and agreed, feeling a warm rush of pride that is unique to self-promoted altruism when you have no idea what true altruism actually is.

Here is how it actually went. We visited three rural villages including Bumbuli, Rombo, and Faraja.  I got accustomed to not having hot water (or light when I showered), using Band-Aids to fix up the holes in mosquito nets, and the casual slang including “Mambo” (“What’s up?”) in Swahili.  We spent the first part of every visit walking miles around the villages, evaluating and triaging local residents.  This included seeking out patients with acute or chronic illnesses as well as evaluating their housing situations and sanitation.  Days later, we would set up a clinic in the center of the village.  Patients would come to us, most of whom we had seen during our triage visits, from the very young to the eldest.  With the coordinated help of local translators and local doctors, we would perform general physicals, draw blood for malaria tests, and hand out the limited medical supplies we had including short-term anti-malarials.

What did I learn during this? When we had no electricity one day and relied upon the sun to look through microscopes for malaria in the blood of our patients, I learned that having technology means nothing when you do not have electricity or infrastructure to uphold it.  When a child had a dental problem but lacked the five dollars to get to the city for proper treatment, I learned that I had just started to peel away the first layer of complexity involved in global poverty and underserved health access.

My eyes were opened.  I was seeing red.  Frustration at the inequity and lack of resources made my blood boil.  However, retrospective reflection has brought me to understand that having frustration is a good motivator.  It is that frustration that led me to medicine and what continues to light a fire beneath me in an effort to unravel and solve these problems.  This is why I will continue to travel, to seek what is unfamiliar, difficult, and learn a thing or two. As Henry Miller says, “One’s destination is never a place, but a new way of seeing things.”  Hopefully, when we put our heads to rest in our comfortable beds and take our heated showers, we will not forget where we have been.

Resident Rotation at Princess Marina Hospital in Gaborone, Botswana

Amana Akhtar, MD

The Hospital of the University of Pennsylvania radiology residency program offers a six-week rotation through Princess Marina Hospital in Gaborone, Botswana.  I was fortunate enough to participate in this elective from January-February 2014.  The following is a short summary of my experience.

A little background:  The Botswana-UPENN Partnership was established in 2001, with the goal of preventing and treating HIV/AIDS related complications.  BUP hires medical staff physicians for Princess Marina Hospital (PMH) and outlying village clinics; these physicians work in complement with PMH hired physicians. Penn residents from different disciplines are chosen to rotate through for up to 8 weeks.

I arrived in January 2014 after flying from New York City to Johannesburg, and then on to Gaborone, the capital of Botswana.  My flatmates included medical students, dermatology and internal medicine residents.  We stayed in flats rented by the university. In order to practice medicine in Botswana, we had to apply and undergo a vetting process, after which we were issued temporary medical licenses.

PMH is an open air ward, designed to mitigate the spread of TB. Every day at 7 am, we would walk to the PMH to attend morning rounds.  The call teams from overnight would present two admissions. As part of the diagnostics component of the presentation, I would assist in reviewing the plain films or CT images printed on film on the light box.

For the first few days during my time at PMH, I attended medicine walk rounds with my Penn internal medicine flatmates. I was able to review films at the bedside with the team.  After walk rounds, I would head to the radiology suite, at which time I would review film, CT scans (PMH has a 16 slice CT scanner), ultrasounds and basic fluoroscopic examinations.

After reviewing my findings with my attending, I would generate a handwritten report, to be typed by the transcriptionist. The reports would return to me for editing and re-review.  Additionally, medicine and surgical house staff would filter in and out of the radiology suite, requesting review of images and discussion of differentials. In this era of PACS, visitors to the radiology department in the US are rare.  However, in Gaborone, house staff routinely requested radiology consults.

The pathology at Princess Marina was fascinating.  Florid imaging manifestations of tuberculosis and HIV sequelae were topics I had only come across in textbooks.  I will also never forget a case we had of a 23 year-old woman with multifocal cannonball pulmonary metastases and brain metastases of unknown primary. Biopsy was not readily available. An astute physician recommended obtaining beta-HCG: 60,000. The patient passed shortly thereafter from choriocarcinoma.

As a women’s imager, I was interested in their utilization of mammography, but unfortunately the unit was not functioning during my time there.  However, I was able to perform breast ultrasound. At Princess Marina, the technologists issue a written read, rather than the physicians. Dr Sesay, my attending radiologist, originally from Sierra Leone, trained in Nigeria and South Africa.

Outside of work, my flatmates and I were able to explore Capetown, South Africa; Victoria Falls in Zimbabwe; and Kasane safari in northern Botswana. Off the coast of South Africa, we visited Robbin Island, where Nelson Mandela was imprisoned for 18 years.

All in all, I had an incredible experience. The people of Botswana were kind and generous. The support staff in radiology, from the technologists to the transcriptionists, was amazing. The warmth and kindness in the hearts of the people I met--I won’t ever forget that feeling.