KITSO

Sunset over Serowe.  Somehow it is one of the most beautiful places to watch a sunset I have ever experienced

Kitso is the Setswana word for knowledge.  So it was chosen as the name for the HIV trainings that occur throughout Botswana.  Since 2001 these trainings have taken place around the country to train health care workers about HIV, the adult HIV trainings are conducted by the Botswana/Harvard Partnership and the Pediatric HIV trainings are done by Botswana/Baylor.  This past week was my first time as presenter for the Kitso and I got to do it in Serowe (my old stomping grounds).  One of the medical officers from Baylor, Margaret, and I traveled to Serowe on Sunday and Monday morning began the week long training.  We had 30 participants, one pediatrician from Bangladesh who has been in Botswana for 4 months, 3 medical officers from India, Zambia and Botswana, 2 Nurse prescribers, many nurses, a dietitian, a social worker, and a few pharmacists all of whom work at the main hospital or the surrounding local clinics.  Monday and Tuesday were long days of lecturing on everything from epidemiology to diagnosis and treatment.  We tried to make it as interactive as possible and after an initial period of shyness the participants began to contribute.

On Wednesday we traveled to the hospital to do the practical portion of the Kitso.  We split the group into 5 groups of 6 and they began to interview and examine patients.  Margaret and I bounced from room to room helping them along as needed.  Many of them were surprised to find 12 year old children who had no idea why they were taking their meds.  Prior to attending the kitso they had assumed that parents and caregivers were disclosing the reasoning behind the medications to the children.  But what they found confirmed what we had taught them - most caregivers are reluctant to disclose to children and do not know how to do it, leading to children being lied to about the reasons and often getting traumatically disclosed when they are older.

One 5 yr old needed her blood drawn for a lab test and one in the group was qualified to draw blood.  So I donned a pair of gloves and got the needed equipment setting out to draw blood as I have done numerous times in the last year (I have actually gotten much better at drawing blood and placing IVs since being here where there is no IV team or phlebotomy team who are comfortable with children as there was in residency).  The girl was not happy with me and was sitting on her mother's lap screaming, but I manged to get the blood from a vein in her arm.  As I took the needle out with my left hand and held pressure over the site with my right thumb I managed to somehow nick my right thumb with the needle.  The needle pierced the glove and there was a little drop of my blood forming under the glove.  My first needle stick injury.  I immediately expressed as much blood as possible from my thumb and washed my hands, but there is still a slight chance of transmission (0.03% chance of transmission after a needle stick if you do nothing).  So I have started on what is called Post Exposure Prophylaxis (PEP) (basically I am taking 3 HIV medications for the next 28 days to prevent transmission.)  With 3 drug PEP the risk of transmission after a needle stick is extremely low, so I am not too worried, but I am truly experiencing what it is like to be on ARVs.  Luckily I have not really had many side effects (many people experience pretty severe vomiting while on PEP but so far I have had nausea and a weird taste in my mouth but have been able to tolerate the medication overall.)  However the medications have to be taken 2 times per day with food and the same time each day.  So I will have to wake up early on the weekends, make sure never to miss a dose, eat dinner at around the same time each day, etc...All of the things that my patients have to deal with every day for the rest of their lives.  I am lucky that I only have to deal with it for a month, but it is really giving me a taste of what life is like for my patients and an even greater understanding of just how hard it is.

Back at Kitso training, the participants presented the cases of the patients they had seen and we discussed all they had learned.  One said, "It was actually a wonderful experience because now I see, wow I really have not been doing this right!"  Friday morning we gave them the post test and found that most had learned a lot compared to their pre-test scores.  90% of them scored greater than 80% and all but one passed.  I just hope that they will be able to put this knowledge to use, since many do not actually work in the ARV clinics and will not be able to use all that they have learned everyday.  But if those not working with it every day, at least learned the diagnostic principles and that every person who presents for any kind of health care in Botswana should be offered an HIV test, I will be happy.   

Plenty of reasons to be cheerful, since it is now spring time in Botswana.  Everything is in bloom, including this plant, which I planted in Serowe and then transplanted when I moved to Gabs and which continues to thrive!