Jane Arnold, a WorldLegacy Leadership and PhD graduate

A summer Sunday morning arrives in Gaborone.  The jacaranda trees are in perfect full violet bloom,  gusty winds come in at  night from the South  blowing plants off the window sills, and we wait for the circling of termites  around the lamplights  as they lose their wings and mate.   The white egrets come in the morning and feast.  I sweep the wings(of termites) off  my small balcony .  The sun drenched dry days of 80 to 90 F have made me buy a broad brimmed hat.

I have lived in Gaborone for exactly are year.  Many challenges are here and I meet them by looking at every day in Botswana as a new beginning.  I lay out my sneakers and blue scrubs (from UNC) at night.  When I wake in the morning I invite myself to work.  Botswana is one of three countries in Southern Africa that maintains a constant HIV rate of 20% among adults 18-39. (The other two countries are Lesotho and Swaziland) The rate of HIV among pregnant women is 33%.  In response the government has launched a free anti-viral treatment plan for all citizens.

The stigma of HIV is profound.  Within the year the government and Harvard’s School of  Public health released a study   done with HIV positive  pregnant women taking anti-virals during and after pregnancy and exclusively breastfeeding their infants for six months.  The rate of transmission  of HIV through breast milk to babies was 1%.  In a joyous moment, a 19 year old police woman I took care of during labor and delivery, who was in the study, sent me a text message that her 6 month old infant was HIV negative.  Such news decreases stigma.  Prior to the study, all HIV  positive moms bottle-fed their infants.   A subtle dynamic exits between social change and suffering.  As HIV testing and treatment become more available , an increasing population of the elderly with AIDS stress the economy and the demand for women to care for them grows.  Children watch their parents die of AIDS because treatment  was not available.  The concentric circles grow and we are left bound together by our silence and dismay.

Bokamoso Private Hospital (BPH) has gone through many changes in a year.  My dear friend and colleague, Nancy Chescheir,  and many other physicians and nurses have left BPH. (Nancy’s commitment to her contract was finished.)  Many others relocated as BPH went through “re-trenchment” related to financial concerns.  We moved forward with no new hires and a shortage of supplies as BPH sorted out the finances.  My role in labor and delivery changed.  All nurses in Botswana are midwives.  My grey hair gives me the role of mentoring younger midwives and assuring the quality of care we give to women.  My work allows me to experience midwifery in Botswana and feel and see the work midwives are doing.  I am grateful.  The group of core midwives except me have been moved to our two clinic sites to do antenatal, postpartum, and well woman care.  The core group does wonderful work and now we are able to see all postpartum women at 2 and 6 weeks postpartum.  I miss my family and good friends immensely.
“A good heart is the medicine of a person.”  Setswana Proverb

Get Over Ourselves:  Lessons from Botswana

At the suggestion of a physician I work with, I went to visit a woman whom has taken in 28 orphans into her home to love and care for them.  Gorata is her name and she has minimal resources.   The children(adults) range in ages from one month old to 23 years of age.   This month they have no water.  The water money has been used to send two of the children who failed 10th grade to private school so they may have a HS diploma.  If a child fails 10th grade, the government does not permit them to go any further in public school.  No electricity is present in the home as they are in the queue for installation of their electricity.  Without electricity they have no refrigeration.  Gorata cooks for her family over a wood fire and moves forward with calm resolve and determination.  As I held one of the children in my arms and looked at her as she spoke. I understood what it means to “get over myself.”

WorldLegacy Graduate Jane Arnold:  Leaflet Seven from Gaborone, Botswana

February 20, 2011
We are in the middle of summer here.  The weather is dry.  The temperature is usually in the 90’s.  I have cactus that bloom well on the windowsill from the western exposure.  My window also looks out on the hospital.

The hospital is in a dire financial situation and has been taken over my two trustees appointed by the court.  Sequestration is the formal British name for such an operation.  Many staff have been let go(re-trenched).  Many have left on their own.  I remain, having gone through 2 re-entrenchments, and have a week-to-week contract.  In the LDRP(labor delivery recovery and postpartum) we have banded together with a fierceness that defies blame and looks only to moving forward doing whatever it takes.  Having gone through the WorldLegacy Trainings I have the determination that allows me to continue.  I have always believed we would survive and still do ……”the secret of the care of the patient is in caring for the patient”.(Francis Peabody, 1925).

In caring for mothers, I often know nothing.  Multi-tasking is mandatory.  Care for the birthing mother, care for the newborn, move to the theatre, or if necessary and care for the mother and newborn.  We have no luxuries in the sense of specialties and I am slow to adjust.  Often I cloak myself in academic tasks when equipment checking, staff training and orientation and my own update of skills is what is needed.  I, again, am learning to be a nurse, an opening I have longed for.  I am pushing my boundaries again and again.  My respect for the midwives here grows with each day.  Making a difference is in degrees of contribution.  We all must contribute and be accountable.

For fun I am growing plants, making cards, and traveling to Mashatu Private Game Reserve in the northeast part of Botswana. The Reserve is untouched by humans.  The guides have lived on or near the Reserve for many years and have their ears to the ground.  They translate the heartbeat of the Earth
The time is late here and I am going to bed wishing you all sweet dreams wherever you are!  With much love!
Jane Arnold CNM, NC90, NC95 and PHD 8
Bokamoso Private Hospital