First Day

It is 1PM.  It is my first day, and after a full morning, I was dismissed for lunch.  Naturally, I eat quickly and come back in an hour; as it turns out, lunch is two hours here, so I find myself with a moment of time.  It is a brutal 90 degrees, and I am sitting outside the pediatric ward, which geographically is little more than 6 rooms, each room smaller than any given CHOP bed.  However, there is much to this space.  Each room is filled with up to 11 patients and their families, mostly spread across mattresses laid on the floor.  I saw 3 of them this morning, and each one makes it progressively clearer that I do not understand the world in which these people live.  Inexplicably, these differences make me feel far more responsible for and connected to these patients.

A child, no more than 4, is slowly sidling her way up to me.  She is being shy, looking away, but consistently making small steps in my direction.  Eventually she pulls herself up on the bench upon which I am seated, and she scoots up next to me.  She is staring at the computer screen, and periodically attempts to press a button.  She does not speak English, and my limited Setswana is apparently incomprehensible.  I wish I had a toy to give her; sadly, I did not think to bring any today.

Across the way from me is a boy who I believe to be her brother.  He looks to be around 2, although I cannot be sure.  His mother cradles him, and his clearly oversized head.  He has multiple vitiligo-appearing lesions along his scalp line, and the entire time I’ve seen him he has a right gaze preference and active right beating nystagmus.  He has yet to attempt any form of communication in the time I’ve sat here.  I quietly ponder how different his life could have been if they were born in America?  Perhaps no different.

The day has been filled with diverse pathology.  The medicine has been familiar but alien.  Every febrile seizure is complicated by a myriad of factors I don’t normally need to address: tuberculosis exposure, HIV status, kwashiorkor.  I feel painfully inept compared to my Batswana colleagues in dealing with these issues.  But we fortunately make a strong team, as they are always happy to offer their expertise and experience in sorting out important from less important details; ultimately, our plan makes sense.

Tonight, I will come home to discover the internet is out.  I will later learn that Spotify, Pandora, Hulu, Netflix, and Amazon Prime all do not work in this country.  I assume the same will be true for HBO Go.  On the plus side, I will also discover the value of (relatively) cheap, delicious South African wine, while enjoying a communal dinner with my fellow travelers.