Episode Four: poinsettias the size of trees

Almost time to go.  I meant to post this image before Christmas but couldn't quite get it up.

Anyway, when I was in Botswana in July, I saw poinsettias - the size of TREES!   Imagine how sad beautiful U.S. holiday altars must look to visitors from Botswana.

Mysteriously I did not take a photograph of any of the actual trees, but I did take this picture.  It shows the inside of the SOS Children's Village and the "family tree" made by the kids who go to pre-school and/or live there.  It is a poinsettia tree!

I hope to write to you next from Botswana.

Episode three: malaria, tuberculosis, and HIV/AIDS

I’m getting my lectures and other materials together, so I thought that it might be nice to tell you a little about the focus of the course I will be teaching, which is called “The Biology and Public Health of Malaria, Tuberculosis, and HIV/AIDS.”

Why those three infectious diseases?  I chose them because they remain significant causes of mortality despite the fact that every single one is preventable, and two of them can be cured.  I also chose them because social categories such as gender, race, and socioeconomic status have strong effects on both the risk of contracting one of these illnesses and also the risk of dying as a result. Additionally I’m a microbiologist and so I chose them for teaching purposes, because one of them is caused by a bacterium (Mycobacterium tuberculosis), another by a virus (Human Immunodeficiency Virus), and the third by a eukaryotic parasite (Plasmodium species).

It is also very interesting that despite the importance of these infections and concentrated research effort, there is no immunization series that can effectively protect children or adults from any of these agents.  (Some studies indicate that an immunization called BCG can protect young children from some forms of severe tuberculosis early in their lives, but this protection does not protect immunized people later in life and can complicate diagnosis of tuberculosis, so it is not used in low-prevalence countries such as the U.S.)  Unfortunately, these three infectious agents have taught us how little we understand the human immune system, which has more connections among cells than are found in the whole nervous system!  Even if we had effective immunizations, we might not have the political will to build the human and physical infrastructure needed to distribute and administer the immunizations where they are most needed.  Certainly the infrastructure to store and administer affordable antimicrobials is not in place, even though those antimicrobials exist.

I also plan to use these diseases to teach about evolution, because all three infectious agents have evolved in response to our attempts to treat them, and in the case of malaria and tuberculosis, we humans have evolved in response to their attempts to infect us.  

The World Health Organization likes to explain the causes of mortality by scaling everyone who died in a given year to 1,000 people.  For the most recent available data (2004), the top ten causes of mortality in low income countries were:

1.     Lower respiratory disease (112/1000)

2.     Coronary heart disease (94/1000)

3.     Diarrhoeal disease (69/1000)

4.     HIV/AIDS (57/1000)

5.     Stroke (56/1000)

6.     Chronic obstructive pulmonary disease (36/1000)

7.     Tuberculosis (35/1000)

8.     Neonatal infections (34/1000)

9.     Malaria (33/1000)

10. Prematurity and low birth weight (32/1000)

Numbers 1, 3, 4, 7, 8, and 9 are directly caused by infectious disease, while infectious disease in a mother can contribute substantially to number 10, too.

For the world considered as a whole, the list looks like this:

1.     Coronary heart disease  (122/1000)

2.     Stroke (97/1000)

3.     Lower respiratory infections (71/1000)

4.     Chronic obstructive pulmonary disease (51/1000)

5.     Diarrhoeal diseases (37/1000)

6.     HIV/AIDS (35/1000)

7.     Tuberculosis (25/1000)

8.     Trachea, bronchus, lung cancers (23/1000)

9.     Road traffic accidents (22/1000)

10. Prematurity and low birth weight (20/1000)

Even though malaria isn’t listed, it is a significant contributor to #10.   Malaria is also a major downer for economic prosperity – people so sick they can’t get out of bed don’t generate as much income or wealth as healthy people.

In Botswana, which by some measures is a middle-income country, HIV/AIDS is the #1 cause of over-all mortality, while tuberculosis is #4.  For children under 5 in Botswana, HIV/AIDS  is the #2 cause of death, while malaria is #4.  Tuberculosis is the most common “opportunistic infection” affecting HIV+ people worldwide, so there is a connection between deaths from TB and HIV/AIDS, with some difficulty in separating the two in some cases.  It is exciting that the over-all crude death rate in Botswana has fallen substantially from about 32/1000 in 2003 to about 8.5/1000, very close to the U.S. death rate.  This is due in no small part to Botswana’s enviable medical infrastructure and the availability of anti-HIV medications (antiretrovirals, or ARVs) and antibiotics to treat tuberculosis.  Check out this animation showing the data regarding the rise, fall, and rise of health in Botswana.  Public health measures WORK!!

Infectious disease remains an important cause of death worldwide, and is likely both caused by social inequality and a contributor to the perpetuation of that inequality.   People interested in the impacts of infectious disease on development might want to check out gapminder.org and look at under-5 child mortality as one of the variables.  There is also a great visual summary of HIV infection data on that same site.

Lest I end with all gloom and doom, it is worth pointing out that this has been a year with lots of good news on the infectious disease front, too, so stay tuned.  And cheers to all the microbiologists out there devoting their lives to making the world a safer place.

Episode two: Preparations so far

The University of Botswana library, July 2008:

I feel busier than an elf in Santa’s shop.  I have assembled a list of advice regarding what to bring along, including what attitude to tuck into my carry-ons.  This advice comes from all manner of helpful people, such as a UB visiting professor from Canada, past ACM faculty directors, Fulbright scholars, American Society for Microbiology volunteers, and the Botswana Harvard AIDS Institute Partnership for HIV Research and Education.  I found a blog written by a Fulbright scholar particularly helpful, so I would like this post to be similarly helpful to others who stumble across it while planning to live in Botswana themselves.

One thing I’m not doing is running around getting a gazillion travel immunizations.  The first time I went to Botswana, in 2008, I got a whole bunch of shots.  This time I know better, so I just want a seasonal flu shot, a measles booster, and some prophylactic anti-malarials for the safari up in the Okavango Delta (wetlands).  The water in Gaborone is very safe.  I have visited twice and always just drank water out of the tap, used tap water to brush my teeth, etc.  I did get a touch of traveller’s intestinal discomfort, but nothing to write home about (though I am a Salmonella biologist, so I would, in fact, write home about anything intestinally notable!).

So far, I am planning to bring….

1.     Too many electronics

a.     A PC laptop for my office in the Faculty of Nursing.  The PC is loaded with all electronic documents needed to administer the ACM Study Abroad program.

b.     My Mac laptop for use at home, via Mascom wireless

c.      My Kindle, because books are scarce and too heavy to bring along

d.     My iPad, to use for teaching (Airsketch!  Keynote!)

e.     A portable LED projector

f.      Extra cables for the assorted electronics to connect to each other and to power.

g.     Two U.S. surge protectors/strips to go with two power converters (220 to 110).

h.     Several cell phones with Botswana sim cards (provided by my employer ACM).

i.       A cooling gel pad for the laptops – it’s going to be hot!

j.       A lock for the laptop at home.

2.     An official letter explaining that the electronics are for educational purposes and must be returned to the U.S. after my visit.   (We'll see how much I get charged for importing all that stuff.)

3.     A neck support pillow for better sleeping on the planes.

4.     Spray-on sunscreen (for the places I can’t reach!).

5.     Two padlocks in case I join a gym or need to put a lock on a closet or … who knows.

6.     Umbrella for sun and rain.

7.     Swimming suit for trip to Johannesburg and possibly for local gym or hotel pool membership.

8.     For teaching, nicer summer clothes than I ever wear in the U.S..  I will still be under-dressed, I’m sure, but at least I will try.

9.   .  Lots of passport photos, notarized copies of my graduate diploma, and a copy of my appointment letter.

10  For sleeping in an apartment without air conditioning:  a “chillow” and a hotflash pillow.

11. Three cooling bandanas (filled with polymer that can be filled with water).

12. Extra pair of glasses and glasses case.

13.  One warm sweater and one warm fleece; supposedly I will feel cold in April/May.  I guess I’ll update you on that one!

14.  As few copies of teaching books as possible.

15. A wooden backscratcher (living alone!)

16. A few travel-to-Botswana/Namibia/South Africa guides.

17.  Assorted over-the-counter meds that might not be available in Botswana, such as miconazole, hydrocortisone cream, aloe sunburn cream, baby aspirin.

18. A lightweight crocheted shawl in case I ever have to meet any dikgosi and have to cover my shoulders with an extra layer.

19. A Visa credit card (not Mastercard or Discover or any other type).

20. Safari related items for going to the Central Kalahari Game Reserve and the Okavango Delta in late February/early March

a.     Raincoat

b.     Tevos

c.      Walking/tennis shoes

d.     Safari pants that can be unzipped into shorts

e.     Traveljohns (if you don’t know what these are, you should look them up!)

f.      Similarly, a GoGirl

g.     Head lamp with extra batteries

h.     Camera with extra batteries

i.       Anti-malarial (haven’t decided which one yet)

j.       Epi pen … plan to assemble a travel first-aid kit for the safari once I have arrived.  I will also buy DEET-containing bug spray once I am there.

k.     Binoculars

l.    Rain-proof stuff sacks and duffel bags

As far as the attitude to pack… the experience of any given faculty visitor appears to be very specific to their living situation and the department in which they are visiting.   The plan appears to be “expect the unexpected;” as Velvet Hills sometimes sings:  “fle-e-ex-i-bi-li-ty…”  Undoubtedly there will be expected problems (collecting luggage in Jo’burg to stay overnight at airport Hilton, checking in again on New Year’s Day to fly to Gaborone, negotiating about any extra luggage or weight, getting e-mail set up from home, learning how to buy local cell phone service....). 

The unexpected problems are the ones that demand the very most patience and good humor, so all I can say is, wish me luck! 

P.S. I've looked around and most estimates for shipping to Botswana are >$300 for 10 lbs of books....so I may have to pay overage charges for extra luggage of teaching-related books.  We'll see.

Episode one: Coals to Newcastle?

Greetings (Dumelang)!

Welcome to my blog about living, teaching, and traveling in Botswana with twenty three students enrolled at one of the liberal arts colleges that belong to the Associated Colleges of the Midwest.  I am usually an associate professor of biology at Colorado College, but starting soon I will be the visiting faculty director of the ACM Study Abroad Program in Botswana.  This position is made possible through a collaboration between ACM and the University of Botswana, through the Office of International Education and Partnerships.  I have visited Botswana twice, but only for brief periods of time.

Why go to Botswana?  Ostensibly, I am going there to teach.  Specifically, I will teach a course on the biology and public health of malaria, tuberculosis, and HIV/AIDS.  Surely there could be no clearer example of “bringing coals to Newcastle” – my expertise in these subjects pales in comparison to the expertise of healthcare providers, microbiologists, and lay people who have lived their entire lives in sub-Saharan Africa.  Fortunately, I am aware that it is something of a fiction that I am going there to teach – while I will teach a course and direct some undergraduate independent study projects, I am clearly going to Botswana to learn.  

And there are plenty of things to learn about.  For example, did you know that Botswana has almost never been at war?  Meanwhile, the U.S. has been at war for most of my lifetime, and indeed for majority of the years of its history.  Books for tourists and other non-Africans make much of various conflict-avoidant cultural traditions in Botswana, as do books Motswana write about themselves.   One celebrated Setswana way to resolve conflicts is to find a solution that leaves everyone reasonably happy, honor intact, rather than winner-takes-all strategies such as simple majority voting. One wonders what a faculty meeting organized around these principles would be like, let alone an entire country!

I’m also very excited to learn from my colleagues at the Faculty of Nursing. Many Batswana, certainly including most nurses, see health as a human right.  This idea is an alien concept throughout most of the U.S..  How does this view affect policy decisions, or day-to-day interactions between clients and healthcare providers?  With few exceptions, I have almost no personal experience with serious illnesses among people “in the prime of life.”  It is, frankly, hard to imagine – even though I have read so very many books about just this.  Nurses in Botswana have also been at the forefront of devising practical methods for preventing mother-to-child transmission of HIV in Botswana, and have disseminated those methods to other countries.  I look forward to learning more about how these practices and policies have come about, and about their benefits and limitations.

I can only hope that the Batswana I meet will graciously accept my coal, teach me Setswana ways of knowing, and enable me to discover some actual gifts to leave behind in gratitude.

A view at the University of Botswana, July 2008