Serenity in Mmopane

“God, grant me the serenity
To accept the things I cannot change;
Courage to change the things I can;
And wisdom to know the difference”

We kept in mind this prayer as four of us drove to the rural village of Mmopane, 15 km outside of Gaborone. We teamed up with Flying Missions in conjunction with Tirisanyo Catholic Commission to connect with home health care volunteers in the community. The day was spent walking along winding dirt paths leading to the local health post and visiting among residents of Mmopane. The village has one Christian church, one health post and one primary school. The home health care volunteers were originally from Mmopane earn approximately one US dollar each day for their services. We were extremely fortunate to be paired with these women; their wisdom and knowledge of the cultural norms enabled us to use our clinical knowledge and feel welcomed into patients’ homes. We would not have had the impact we did in the community if it were not for these important liaisons.

While we worked with the Tirisanyo organization last week, today was our first day doing home visits and we did not know what to expect. We were all excited for the experience but also felt apprehensive. The four of us split into pairs and each went with two homecare volunteers to their visits. The cultural importance of introductions was again highlighted and we all found ourselves following the volunteers’ lead. Following our visits, the four of us sat down and spoke about our thoughts and concluded that our emotional responses to this experience was one of the more significant aspects of this clinical site.

One of the most significant feelings was fear of contracting TB. All four of us visited at least one patient who had been diagnosed with TB and while on treatment, adherence to medication could always be an issue. Within a new culture, we struggled with whether to be compliant with American standards of care such as whether to wear gloves or put on a respirator mask.

Another concern of ours was the patient’s ability to commute to the clinic...while physically close to the community, sandy paths and mobility assistive devices prohibit some of these patients from visiting the clinic. Megan and Linden visited an elderly woman who had a stroke two years ago and found her sitting in her own soil on a thin mattress. The woman’s entire right side had been paralyzed from her stroke so she was not able to move independently however she also did not have any disposable underwear to aid with her incontinence. Although we arranged for an ambulance to bring her to the clinic, we had to leave Mmopane without knowing the outcome.

Meeting patients in healthcare settings that are controlled through family decisions as opposed to settings that are controlled by health standards, we struggled with a conflict between two worlds. Normal recommendations such as appropriate nutrition guidelines are based on assumptions that patients have what we interpret as basic necessities (a place to cook, food to eat, access to medical supplies). We were forced to change our recommendations and rely on our observational skills. For instance, when asking patients about their appetite, we had to look around the home and observe whether there was any food in the home to begin with.

No matter how much or how little we helped the patients or their families, they were all so gracious for our presence and any assistance or assessment skills we could offer. All in all, we were grateful for the opportunity to leave feeling as though we learned far more than what we gave.

Posted By: Linden Spital, Megan Rogers, Bridget Sullivan and Grace Oppenheim.