Photo series: The Nile

Nile river rafting trip. (I am front left of raft, next to Dr. Paul Mullan, in green.) Story to follow.

Botswana destination #7: The Botswana-Baylor Children’s Clinical Centre of Excellence

The Botswana-Baylor COE

This is where I work. The Botswana-Baylor Children's Clinical Center of Excellence (COE) was opened and officially dedicated by His Excellency Mr. Festus Mogae, President of the Republic of Botswana, on June 20, 2003. The facility was the first of its kind on the African continent (since followed by others in Uganda, Lesotho, Swaziland (where I used to work), Malawi, and soon Tanzania. The Botswana clinic is one of the largest providers of highly active antiretroviral therapy (HAART) for children in Africa. Since its inception, over 2,000 children have been initiated on HAART by Botswana-Baylor staff.

As part of the Government's National ARV Program known as MASA (literally, "new dawn"), we provide comprehensive treatment and care services to all Batswana children, free of charge. The clinical team consists of nurses, doctors, social workers, a psychologist, translators, M&E/data officers, and others.

Thanks to the Pediatric AIDS Corps Program, Baylor supports over half of the paediatric specialists in the country.

My office is on the second floor. From there, I help to coordinate the COE’s programs, which in addition to direct provision of ARV care include: nationwide clinical mentorship and didactic training in pediatric HIV prevention care and treatment (for health professionals as well as laypersons); pediatric TB/HIV diagnostic and treatment support; client home visits; adolescent-specific services; technical support for several areas of pediatric sub-specialty care; and participation in national guideline/policy advisory committees (with foci ranging from TB/HIV to national research protocols, IMCI to HIV prevention).

These programs enjoy funding support from UNICEF, the CDC, the Botswana MoH, and others. If you want to learn more, contact me or, better still, drop on by for a visit.

Photo series: We wish you well

L to R: Dwight (leaving for ID fellowship at Duke), Norma (returning to her ID faculty position in Houston), Paul (ER fellowship at Texas Children's Hospital, and Edwin (Doctorate of Public Health Program in Houston)

You will be missed. Come back soon.

Selected quote #5: "I am so happy.”

A man came up to me earlier this week in the Princess Marina Hosptial corridor and said this. I did not know him. I could see that the man was indeed happy. Still, I was caught a bit off guard, and I paused for a second or two before responding.

“Why are you happy?” I asked.

"Because I am just from the lab. My CD4 count is high. I am strong."

"Then I am also happy," I said. 

And I was. Very.

Selected quote #4 "You are growing!"

Gloria, one of our Botswana nurses, excitedly told me this upon finding out that it was my birthday today.

While I certainly hope that this is the case, it immediately brought to mind a short speech given in our waiting room this morning. After the morning song, one of the mothers spontaneously stood to thank the Baylor staff for helping Botswana's children remain healthy despite having been born with HIV. Surrounding her, there were literally dozens of healthy children, children who, thanks to ARVs, now have the chance to grow up. Just a few years back, there was no medicine, and many did not live. Growing older alongside these children is the most wonderful birthday present imaginable. 

Botswana destinations #5 & #6: Wimpy and Steers

 Image: http://www.sonoma.edu

Want a hamburger? Wimpy and Steers are the fast food burger leaders in these parts (though, believe it or not, there is a McDonalds three hours east of here in South Africa). Wimpy, named I suppose after Popeye’s burger-loving sidekick, has good milkshakes and coffee, and they serve a cheap and relatively fast English-style breakfast (eggs, bacon, etc. etc). I just ate it this morning. Steers makes a good chocolate-dipped cone, reminiscent of the Southern US food chain Dairy Queen.

As for the burgers, not to be too critical, but, well, as a child I helped my father raise a cow actually named "Big Mac", and, though that does not give me any real authority, I must say, to be honest, that burgers here are a touch meat-loafy.

This is no surprise, and for three main reasons: (1) Hamburg, NY, where the hamburger is said to originate, is over 6,800 miles from Botswana; (2) the original Hamburg Sandwich dates back to 1885, when the Menches brothers of Hamburg, NY ran out of pork and, reluctant to butcher more hogs in the summer heat, decided to try/fry beef. This is ample time for recipe drift; (3) Even the Menches brothers found fried beef to be bland, and so added coffee and brown sugar. So, not even hamburger #1 was 100% beef. 

Despite my efforts, I have uncovered no secret recipes related to the common spices/additives used in Wimpy and Steer. (Believe me, I have asked.) My guess is corn starch, Worchester sauce and perhaps some soy.

As for sauces, except during WWI when anti-German sentiment led to the US changing the name to salisbury steak (want freedom fries with that?), the hamburger has thrived worldwide, leading all other portable, meat-between-bread recipes. The meat sandwich has therefore been subject to toppings ranging from guacamole to chili to "Thousand Island Dressing" to BBQ sauce to queso, and that is in the 48 contiguous States alone. Hawaii and Alaska have tried pineapple and lox, respectively. The Germans, sauerkraut.

The African toppings, while high in volume, are derivations of the standards: relish-laced ketchup at Wimpy (probably better on a hot dog...but franks not on menu) and “Steer Sauce” at Steers (a type of sweet BBQ, though could use more hickory). When ordering, to avoid soggy disappointment, I recommend ordering sauce on the side…and dipping. Or, you can do breakfast at Wimpy's, drive three hours east to McDonalds for lunch (indistinguishable from stateside version), then head back for a Steers dipped cone, the perfect afternoon snack.

Search terms - A cultural encounter, Part 4 (of 4)

Continued from Parts 1-3 below.

The singing of “Kumbayah” continued.  

The choir comprised a hundred sundry Baylor doctors, nurses, social workers, receptionists, translators, parents, grandparents, aunts, uncles and children. Represented countries, in addition to Botswana, included Kenya, Uganda, Zimbabwe, and South Africa. Oh, and Texas.
“Someone’s singing Lord, Kumbayah.”

I thought briefly of my sister and her husband in New Orleans, where Cajun, French-soaked accents once melted the words “come by here” together. Sarah and Alan, previously in the Peace Corps in Nicaragua, are now in medical school. They are going into global health, and they are going to have a baby soon. What a lucky child that will be. All of the bedtime stories and apples she wants.

I thought of my brother Nick, a musician touring from his hub in NY, NY, where he volunteers for Musicians on Call , a non-profit that sends performers to the bedsides of the sick and dying. I wondered if they ever sing Kumbayah. That is probably the song I would choose to hear.

Looking at the children in the clinic lobby as they looked back at me, I thought about other songs that I used to sing as a child. One started with the words “I’ve got the peace that passes understanding down in my heart to stay.” I never understood the song and always thought that we were singing about Tuesday, and wondered why the other six days were different. As I was growing up, my mother, a pediatrician, used to have Tuesdays off from the hospital, so I thought maybe that was it.

Today, at almost 34 years old, I do not know who that songwriter was who stated that he's/she's got 24-7 transcendental peace, but I can say with confidence that I am not quite there, not on Tuesday, Wednesday, or any other day. Not even most Sundays. I am, like many, virtually peace-free most of any given week's seven days, craving respite while at the same time reveling in the clarity and motivation provided by peacelessness.

As the last verse of “Kumbayah” was underway, I thought of another song from my childhood, one that I liked a lot, one that I had not sung in many years. Then suddenly it was my turn to speak. I said hello and asked if I could sing that song. The answer was an enthusiastic yes. (This is no wonder: A solo from a pallid foreign guy wearing a white collar shirt and tie is guaranteed entertainment.)

I began with the words, “This is the day,” my mediocre singing voice bouncing off the windows and concrete walls of the clinic lobby. Many of our 85 clinic staff attend the morning prayer, and were standing behind me. A few of them, recognizing the song, repeated the lyrics “[This is the day]” This made me very happy, and I continued. 

“…That the Lord has made.” [That the Lord has made]

“Let us rejoice.” [Let us rejoice]

“And be glad in it.” [And be glad in it.]

And then, as the song indicates, I repeated the verses.

Then there was quiet. The audience, satisfied by the spectacle, clapped for us.

And so for a few minutes in the packed lobby of an HIV clinic in Botswana, someone was singing. While I do not know if God came by as we had requested that morning, I can say this:

In our impoverished, unjust, sick, hurtful, love-hungry world, sun, rain, and family are not always provided in the proportions we’d like. Health, food, friendship, even love sometimes disappoints. The peace that is said to pass understanding, that peace that we crave, often passes us by for reasons we don’t understand. No matter how many books, chapters, and verses we read, no matter how many songs we sing, peace is a hard thing to chase down.

Yet, no matter how garbled or offtune our words, and no matter how seemingly senseless our lyrics, the songs matter, and we must sing them. We must sing them with others. We must sing them to others, especially in their darkest hour. When alone in life’s throes, we must sing them to ourselves. We must work like heck to ensure that the chorus remains healthy and able to sing along. We should see that our children live long enough to learn the words and join in. 

To me, it seems likely that one of the reasons that God goes through the trouble of making more days is to give us an opportunity to do this. 

Fortunately, it is also a lot of fun.

* While writing about the song with the lyrics “the peace that passes understanding,” I read that the words come from the biblical verse Philipians 4:7. The book reportedly took its name from Philip, the famous king of Macedon(ia). My last name Phelps is derived from Philip, which is neither here nor there except that I had always been told that this was an English name derived from the Greek name Philippos which means "friend of horses" (philos="friend"; hippos="horse”). Now, despite being Texan, I have feared riding since my sister’s horse "Fido" tried to rub me off on a tree out by the Phelps barn in the early 90s. I am therefore relieved that there is a non-secular, regal genealogy that I can claim as an alternative. Given that everyone here in Africa, upon meeting me, immediately asks me if I am swimmer Michael Phelps' brother, and given that I almost always indulge them and say yes, I suppose that it does not much matter.