March 2006 Archives

When the volunteers from Bots 3 and Bots 4 were together for our PEPFAR M&E workshop a couple weeks ago we took some time to brainstorm packing tips for future PCTs. I promised that I would share them here.

Ziploc baggies: These are a precious commodity here! Everyone I know washes them out so they can be re-used. Bring them in all different sizes. The super large ones are great for packing toiletries in to prevent leaking all over your clothes. Brian and I brought some with us and then used others as packing supplies in the box of stuff we sent to ourselves before leaving.

Cash: In medium sized bills (like 20’s and 50’s). I know that Peace Corps suggests not bringing extra money, but it's really kind of absurd. There's a difference between being a "credit card volunteer" and using money from for traveling and nice things every once in a while. You should also know that there are no banks in any of the villages where training is being held. If you know that you will want extra pula during training try to get it at the Jo’Burg airport, because that will likely be your last chance to exchange money. (You will get money for food at staging and a small walking around allowance during training. It’s usually enough to get by. Most people who used their own money during training used it for drinking or buying souvenirs and extra things.) Also, somebody asked about bringing money for a cell phone. If you want a phone during training I recommend bringing the cash. Otherwise you will get a settling in allowance that is enough to buy a phone and other essentials.

Compact umbrella: Umbrellas are not just for the rain in Botswana, they’re also for the hot burning sun. You will be able to buy umbrellas here but if you want a good quality umbrella bring it from home.

Hand sanitizer: Let me just say that I work at the District HEALTH Team and that we don’t have soap in the bathroom. We operate on a strictly BYOSTP policy (bring your own soap and toilet paper.) Hand sanitizer works wonders. A PCV friend has nice smelly hand sanitizer from Bath and Body Works. Don't worry about packing a two year supply because it is possible to buy regular old sanitizer at the store (even if it doesn't smell as nice.)

So I’m in a government vehicle around back of the office on my way from a meeting today. I’m just casually looking out the window and notice what looks like a dead leopard. There was a crowd so when we arrived at the office I immediately went to pick Brian and check it out up close. Sure enough it was a dead leopard! It was caught on somebody’s cattle post outside Molepolole where it is legal to kill wild animals if they threaten humans or attack your cattle. It was probably being skinned so the fur could be destroyed. (This is common practice. When elephants die even of natural causes, for example, the government takes the feet and tusks to be destroyed. That way there’s no market for poachers.)

Who has dead leopards in back of their office? I’m pretty sure that it’s about the craziest thing I’ve seen in Molepolole. Seeing it was just another small reminder that, I live in Africa. How cool is that?

While riding in a taxi I once passed a guy taking on a cell phone as he was driving a donkey cart. It is illegal in Botswana to talk on cell phone while operating a motor vehicle, but I not sure if a similar prohibition exists for donkey cart drivers. The proliferation of cell phone networks into the deepest reaches of Africa may seem paradoxical—that the world’s poorest people would use what was recently considered a luxury item. In most “developing” countries, however, cell phone networks have gone many places where ground service has never been, and probably never will be, and are essential to small business and economic growth. This is definitely true in Botswana.

The weeks are quickly counting down until the new training group arrives in late April. I am so looking forward to seeing the faces behind all the emails we’ve been receiving.  Today I thought I’d share some miscellaneous thoughts on phone calls …

Cell Phones
Easily 100 percent of volunteers in Botswana have a cell phone. Even volunteers who live in villages with no reception have phones they can use when they travel to places that have reception. Cell phones are our life lines – not just to the U.S. but to each other via SMS messages. I don’t know how I would survive without my friends and SMS messages.

A large majority of volunteers have the Nokia 1100. It’s an extremely basic model, but very reliable. The trick to cell phones in Botswana is that they are “open” SIM cards. That is, they’ll accept SIM cards from different companies. When we went to Cape Town we bought a SIM card for South Africa and just plugged it into the phone we have in Botswana.

If you own a phone already it is probably worth bringing along. Other volunteers tell me that it is possible to have phones from the U.S. “opened” at cell phone shops here. Even if your phone can’t be opened the Nokia 1100s are about P400 and, as I said, very reliable.

My attempt to answer some questions about PMTCT from incoming PCTs. I am so passionate about PMTCT, I will try to keep this to just the basics.

The Botswana PMTCT Program was piloted in Gaborone and Francistown beginning in 1999. National roll out of the program started in mid-2000 and all health facilities offered PMTCT services by November 2001. The PMTCT program is essentially a collection of services to prevent mother-to-child transmission (MTCT) of HIV. Those services are integrated into routine maternal-child health (MCH) care in all public health facilities.
The services available in Botswana include:

• Routine HIV testing of pregnant women (as opposed to voluntary counseling and testing (VCT)
• Post-test counseling
• Referral for antiretroviral evaluation and therapy (HAART)
• Antiretroviral prophylaxis (for all infants born to HIV-positive women and for HIV-positive women who do not qualify for HAART)
• Infant formula (available at no cost to HIV-positive mothers)
• Infant HIV testing

Approximately 35-40 percent of HIV-infected women who breastfeed and do not take antiretroviral prophylaxis will pass HIV to their infants. With the services of the PMTCT program (ARV therapy/prophylaxis and infant formula) the rate of mother-to-child transmission (MTCT) is reduced to 5-10 percent. Let’s look at that in real numbers:

• There were 4,070 deliveries in Kweneng East District for calendar year 2005.


• The prevalence of HIV in Kweneng East District is approximately 31.5 percent among pregnant women. This means that about 1,282 of the deliveries in 2005 were to HIV-infected women.


• If we assume a MTCT rate of 40 percent without intervention (i.e. ARV prophylaxis and infant formula), an estimated 513 of the infants born last year would be infected with HIV.


• Use of the interventions available in the PMTCT program, however, reduces the MTCT rate to 5-10 percent or 64 – 128 infants. That’s an 87.5 percent reduction in the number of HIV-positive infants.

Here are my answers to a few more questions about being a District AIDS Coordinator Volunteer:

Do you work on a second project?

Yes, well sort of. I guess I am lucky in that my position as a DAC volunteer brings me in contact with support groups, youth organization, community leaders, etc. Much of the work I do in the community is loosely related to my position as a District AIDS Coordinator. Furthermore, I am able to use the resources of the office to help other PCVs, and myself, with small projects such as HIV testing campaigns or art competitions.

I would say that my biggest secondary project will be starting a peer education for behavior change programme with workplaces and organizations for the purposes of targeting men or youth older than 15. I have found, through national studies and personal experience, that while HIV awareness is very high, most people cannot connect modes of transmission to various behaviors. In other words, people have heard catchy slogans and know the alphabet soup of AIDS services available, but there is still a lot of confusion about how and why HIV is transmitted. Heather and I are in the process of writing a locally relevant peer education manual.

How far do you live from your office?

I live 7.3 km from my office. That is the farthest of any Peace Corps volunteer in Botswana from their place of work. The Botswana government agreed to house volunteers within walking distance of their workplace. When that is not possible, like my case, the local government is supposed to provide transportation or reimburse volunteers for taxi/combi rides. Ninety-five percent of the current volunteers (in any programme) are able to walk to work. Many even live on the premise of the clinic or right next to the Rural Administration Centre. Among the current DAC volunteers, two take a taxi, one rides his bike, and the rest enjoy a short walk.

Do YOU feel disconnected from your community?

Yes and no. First of all, Peace Corps is a different experience for a couple than a single volunteer. In addition, Molepolole has over 60,000 residents and it is very spread out. Technically, we are a village, but it doesn’t feel like a village in my neighborhood or along at the shops along the main road. It is a real pain to get around the village from my house during the day and it is not a good idea to be walking long distances or taking public transport at night. I am friendly with most of my neighbors, but most are government extension workers who are not from Molepolole. In addition, most of the people I work with are not from Molepolole and many of them commute in from Gaborone or another village. But, coaching the basketball team helps me meet a lot of people around my age and I seem run into someone I know no matter where I go. On the whole, I am not connected to the community as much I would want to be, but I don’t feel disconnected either.

Let me know if there is anything else you want me to answer or discuss.

One year ago last week our training group arrived for staging in Philadelphia with 27 people. One year later and all 27 of us are still here. This is virtually unheard of in the world of Peace Corps. The training group that arrived after us in September lost five out of their 10 members by the end of training – two of those in the first week. The group before us lost a member just getting off the plane in Johannesburg.

I can’t place my finger on what makes our group so strong. Individually we are all very unique. In our uniqueness, however, we mesh very easily as a group. Part of that is the fact that we trained together so once we made it through training we were like family. Another part is that we all try very hard to remain connected with one another by traveling through the country.

One of my major projects at work has been writing quarterly reports for the PMTCT program and Routine HIV Testing. Our office receives monthly reports from all the health facilities in the district so when I started I created a spreadsheet to consolidate the data and then every quarter I analyze the major indicators (uptake of testing, prevalence among pregnant women, etc.) (This was not happening before I came. In fact they were not even keeping track of what facilities turned in their monthly reports. In the year before I came we missed approximately one-third of the reports every month. Just improving the reporting by facilities has been a major victory.)

One of the things I noticed in writing the quarterly reports was that our two busiest facilities had the lowest percentage of group education/pre-test counseling. For Kweneng East District our education/counseling uptake is about 84 percent – that is 84 out of every 100 new ante-natal care clients are educated/counseled. The uptake at these facilities was 58 and 70 percent. This was a major problem for a few of reasons. First, these are our two busiest facilities; they see almost 25 percent of all the new ante-natal care clients for the whole district. Secondly, group education/pre-test counseling is one of the most important parts of the PMTCT program. Out of the women who are pre-test counseled every quarter, 90-95 percent of them agree to be tested. So if you’re not educating/counseling women your testing uptake will automatically suffer. Finally, it’s a problem because the HIV prevalence rate in that region is the highest out of all the regions in the district.

I’ve had a few volunteers with the next training group ask just how cold winters really are here. It reminded me that the literature Peace Corps sends out is conservative in it’s suggestions about the weather. Unfortunately, a lot of what determines how cold the winters are is how far north or south your site is (which you won’t know until almost the end of training.) Also remember that below the equator it gets colder the further south you go. That’s the opposite of living in the U.S. and it took me a while to get used to.

From the June through mid-August or so it got pretty chilly in Moleps, especially at night and in the mornings. During the day it would warm up but it was cool enough that I wore a cardigan at work most days. The coat I brought has a fleece jacket that zips-out. I never found it cold enough to need the outer lining but I would wear the fleece jacket if we went out at night. I wore wool socks a lot at home because the ground was cold to walk on and slept in flannel pajamas. We also had a little space heater that we used a lot at home and my office is heated.