Proof that Diet Coke Really Is Magic

Short on eggs? Out of milk? No vegetable oil on hand? Turns out that you can dump a can of Diet Coke into a box of brownie mix (well, at least the Botswana/South African kind of brownie mix) put it in the oven (if you have an oven, which I don’t) and get some slightly odd-textured but passable brownies!

Na: ?

When I was up at Nyangabgwe Hospital in Francistown, one of the country’s two big public referral hospitals, one of the doctors was telling me about treating a woman with major blood sodium abnormalities, given that the hospital had run out of the assay to measure a person’s blood sodium level. (For you non-medical folks, sodium is the first electrolyte you report and is basically checked at least once a day for anyone in the hospital in the U.S.). I'm trying to imagine hospital life and clinical diagnosis and monitoring without even basic lab values; I really do want to try a full rotation here if possible.

Sunset Swimming (and Large Insects)

It’s now warm enough (boy, is it!) to swim in the outdoor pool near where I live. It’s a pretty nice pool, 25m, slightly salty instead of highly chlorinated, and made better if my goggles are a little foggy and I can’t see the crud. Yesterday a distant relative of a mutant grasshopper--perhaps the largest insect I have seen in my entire life--was thrashing about in my lane. I lifted it out with a kickboard to toss it far away, and it was actually heavy on the kickboard. Yum.

The pool is open late, which is key for after-work swimming. I generally swim through about 60% of the sunset (approx 6:30) then hurry home, since it's not really a great idea to walk home when it’s dark.

While I can generally remember to drive on the left in Botswana, I have much more trouble remembering to swim on the left. I keep forgetting and wreaking directional havoc when there is someone else in my swimming lane. I have met some friendly people at the pool (crashing into people has its advantages!), many of whom are not shy about asking for swimming tips. Since Botswana has no coast, no real lakes, and no year-round rivers in the south, it seems the majority of people never learn to swim. There’s one girl, probably around 16, who is there every Friday happily dog-paddling and wants me to teach her backstroke. I got her started on trying to learn how to float on her back first and we’ll take it from there.

What else? Oh, next weekend I am planning on attending “Botswana’s First Hip-Hop Extravaganza Experience” I mean, how could miss something like that?

Drug-resistant TB

This is, obviously, all over the news. I'll paste the article below.

Deadly TB detected near S.Africa-Botswana border

06 Oct 2006

JOHANNESBURG, Oct 6 (Reuters) - South African health officials reported 10 new cases of a highly drug-resistant strain of tuberculosis on Friday in a province neighbouring Botswana where it had not been detected before.

Laboratory tests confirmed four people have died of so-called XDR-TB -- two since July -- in the North West province, which borders Botswana.

Six people were being treated, an official said. One of the six patients was a visitor from neighbouring Lesotho, a tiny nation surrounded by South Africa, which raised concerns the highly contagious disease could cross national boundaries.

"We believe there may be reason for concern but no reason for alarm. We are making an appeal to our community to strengthen their efforts to find cases of tuberculosis and support those who are ill," Lesiba Molala, a spokesman for the North West health department, told Reuters.

"There is a free movement of people. So it is hard to say how much more work needs to be done (to contain the disease)."

The latest figures bring the total XDR-TB death toll in South Africa to 78 since January 2005. The other known deaths were in the eastern KwaZulu Natal province where the super bug was first discovered.

TB is the leading cause of death in AIDS patients as it thrives in weakened immune systems.

Most of those who have already died were HIV-positive and officials have expressed concern that with one in nine South Africans infected with the virus that causes AIDS, many people may be vulnerable to the more virulent form of TB.

The latest cases of XDR-TB were detected after North West health authorities scoured hospital records of TB patients dating back to 2000, following attention drawn to the disease by the World Health Organization.

The WHO was among the international health bodies represented at an emergency meeting in Johannesburg last month to determine how to prevent the disease from spreading across the southern African nations.

More pressure mounted on South Africa to stamp out the deadly virus in September after the discovery of six cases of XDR-TB in the Gauteng province, the country's economic hub encompassing Johannesburg and Pretoria.

TB, an airborne bacillus that can be spread through coughing or sneezing, can mutate when patients do not complete or are careless with their treatment or are dispensed inadequate antibiotic cocktails.

Signing Consent Forms

I saw something today that I’ve never seen before. There are, of course, consent forms that patients must read and sign before participating in any of the studies or sub-studies. Most of the patients have at least a primary education, but older patients may not, and the nurses generally read the forms to all of the patients, in part to help those who are not literate. Patients need to write their name and the date, and I’d seen a few patients who did not know how to do that (one man yesterday, for example, inked his thumbprint on the signature line, and a nurse not involved in our organization came to discuss his understanding of the study and then co-signed). There is no embarrassment or surprise over this, as best I can tell.

But today a middle-aged woman came in. This patient had never learned to read or write her name, either, but she was clearly well known to the nurse. With little discussion, the nurse wrote the patient’s name in large letters at the top of the page. The patient then painstakingly copied her own name, not letter by letter, but as a series of connecting lines, copied by sight—draw the left-most line of the letter “A,” look back up and draw the middle bar, look back up and draw the right-most line. It took at least 8 or 9 minutes for her to copy her name, and another 3 or 4 to copy the numbers of the date. I realized that I had never thought much about exactly what it means to be totally illiterate; even when I watched patients make their marks rather than write their names, it did not make anywhere near the same impression. This woman was so determined, laughing a little about how slow she was (like grinning at me and shaking her head when she finished the name and realized she still needed to do the date). Because we had the luxury of time, she was able to maintain her…dignity? independence?…I think, mostly, control over the situation.