Out of Africa

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Jan. 16, 2013

Out of Africa

Trinity students come home sobered—and successful—from summer internships at pediatric AIDS clinics in Swaziland and Botswana

Trinity University-Out of Africa
Barley Halton takes time out for fun with village children.

Katie Ogawa had no idea how much worse it could get. For weeks, the Trinity junior had been interning at the Baylor International Pediatric AIDS Initiative (BIPAI) clinic in Botswana. BIPAI clinics work with outpatient children with HIV and AIDS, helping keep them on the anti-retroviral therapies they need to stay alive. The clinics, now active in more than ten countries hard-hit by the AIDS pandemic, are modern and, in the words of Trinity biology professor Robert Blystone, "state-of-the-art, comparable to what you'd find in the United States."

Now, however, Ogawa was taking her first tour of the public hospital, not 100 feet away from the BIPAI clinic. On the blog she kept during her internship, Ogawa described the scene:

There are no separations between the beds. Some beds are on the floor. It felt like there were people everywhere! I might have been most surprised when I saw the "procedure room." It was just another room, not exactly clean nor tidy. The "table" that all the procedures were done on was much like one found in an athletic training room, but the fabric was quite torn up. I was also told that needles are commonly stuck in the table, like a pin cushion. My mind quickly jumped to the rate of HIV here as my hands remained in my pockets.... There are no "visiting hours" or times when the parents go home. The mothers are to take care of the children, not necessarily the nurse. That is to say, each bed had a child and a mother.

It was a vision of the status quo of pediatric AIDS treatment in Africa, minus the resources, expertise, and infrastructure of international non-government organizations like BIPAI. And it wasn't a pretty sight.

Ogawa was one of four Trinity students who volunteered last summer in BIPAI clinics in Botswana and Swaziland, small southern African countries where the HIV infection rate tops 25 percent. BIPAI was founded by Dr. Mark Kline, '79, now Physician-in-Chief at Texas Children's Hospital in Houston. The seed for BIPAI was planted in 1996, when, on an official trip to Romania, Dr. Kline toured hospitals, clinics, and orphanages and saw children dying from lack of access to anti-retroviral drugs commonly available in the United States. Upon his return, he began to mobilize donors and doctors to build an organization that would eventually serve twelve countries across Africa and the world.

Blystone, who taught Dr. Kline three decades ago, arranged the learning opportunity for his  current Trinity students. "The function of BIPAI's program is to provide medical care for children who are HIV/AIDS positive and to help them toward a more normal life, primarily through the use of anti-retroviral therapy," he says. "It works. Mark has children moving into their teenage years who would have been dead ten years ago."

Much of the Trinity students' time was spent working with teenagers living with HIV/AIDS in "Teen Club." Their work focused on creating an environment of trust for young people who may have to hide their HIV/AIDS status in their home communities. "It was really exciting to see them just be normal kids, normal teenagers," says senior Katie Garrett, who volunteered in Swaziland. "The HIV treatment is so successful for these kids, they're able to live into adolescenthood. That's exciting; they're kind of a new group."

Trinity University-Out of Africa
Katie Garrett helps a young friedn during her internship in Swaziland.

Garrett and her fellow volunteers had to adjust to some disquieting quirks of modern African culture. For instance, while preparing snacks for Teen Club, Garrett quickly learned that many club members hated the taste of peanut butter. This is because Plumpy Nut, an ultra-low-cost malnutrition supplement, is made from a peanut butter base. Many poor African children associate the flavor with traumatic experiences in hospitals and clinics.

At the same time, the volunteers also witnessed a stirring resilience among the HIV/AIDS-positive teens with whom they worked. On her blog, Ogawa describes a typical day at Teen Club organized around the theme of the Olympics. Volunteers organized races and other events. "At one point during a race, I looked to the side and one of the boys with crutches was playing soccer in the parking lot with some other boys," Ogawa wrote. "Seeing him pass the ball with his crutch was truly inspiring."

This non-credit summer abroad experience, as designed by Blystone and Kline's staff at BIPAI, aimed to give undergraduates a taste of international public health opportunities and challenges in two countries that are sorely underserved yet politically stable. "I wanted students to develop a broader perspective of health issues, to understand how health issues fit into the broader geopolitical domain, and to see how they as undergraduates can make a difference," Blystone says. The pilot program was, by all accounts, a success.

In preparation for their trip, all four students took a one-hour course with Blystone in Spring 2012. The seminar included discussions of local customs, child psychology, and HIV/AIDS specifics; guest lectures from the likes of professor Alfred Montoya, an anthropologist who studies HIV/AIDS control in Asia; a visit to Houston to talk to Dr. Kline's staff; and Skype conversations with older students from other universities who had visited the clinics in question.

"Now they're in another seminar course," Blystone reports. "They're missionaries now, telling other students what their experiences were like." He hopes that Trinity's partnership with BIPAI will continue and become official over the next few years. However, he cautions, that will mostly depend on finding better funding to help future students cover the expenses of overseas travel.

With all this preparation, students found themselves itching to get involved in the work of BIPAI beyond Teen Club, pill counting, and shadowing doctors. Looking back, students agree that volunteering at BIPAI, and in Africa generally, is not for the meek. "You need to be a self-starter, someone who's motivated to come up with ideas, take initiative, and start projects on your own," Garrett says. "You have the resources to come up with ideas and make something happen in the short time that you're there, but if you don't have the self-starting attitude you're just going to end up following the doctors around all the time."

Trinity University-Out of Africa
Barley Halton takes time out from developing plans for a model garden on
BIPAI clinic grounds to play with local children. 

For Garrett and her fellow Swaziland volunteer, junior Barley Halton, that meant developing a pamphlet for Teen Club and writing a grant proposal for the Swaziland BIPAI clinic. The proposal was based on a keyhole garden initiative in nearby Lesotho that they'd learned about from BIPAI doctors. Using only easy-to-find materials like straw, sand, dirt, tin cans, and mulch, Lesotho NGO workers had devised a way to build recycled water filtration systems to encourage the planting of backyard gardens in water-poor areas. Garrett and Halton hoped to replicate the model in Swaziland.

"We spent a lot of our time researching how we could get these materials and finding prices," Halton says. "In the end, we presented the project to the director of the clinic. A plan was drawn up to create two of these gardens on the clinic grounds. That's now in process. Model gardens act as teaching aids for patients, to show how they can create their own food supply. There's a direct relationship between progressive HIV and malnutrition."

On their last day in Swaziland, Garrett and Halton met with a representative of a local non-profit to present their proposal. The meeting-and the proposal project in general-was a success. "It fell almost perfectly in line with our goals, and within an hour, we made a deal to partner with their organization," Garrett wrote on her travel blog. "We found funding, labor, and assurance that our project would come to life." 

The four weeks in Africa brought highs and lows. For Ogawa and her fellow volunteer Paige Patrick in Botswana, the highs included striking up a friendship with the aunt of Botswana's current president, Ian Khama. The two Trinity students met regularly for tea with the elderly British-born woman, who regaled them with stories of her youth in Botswana and her sister's controversial marriage with Sir Seretse Khama, the leader of Botswana's independence movement and the nation's first president.

A more challenging aspect of the trip came when unpracticed students were thrust into the sensitive role of representatives of the international medical community in societies that sometimes view Western-style medicine with skepticism. Ogawa, a Christian, was working with a teen girl in the BIPAI Clinic's "Adolescent Transition" programs, asking questions about her understanding of her HIV diagnosis, when the patient suddenly asked Ogawa how she could believe in God when HIV/AIDS existed in the world.

"I was taken aback because we were talking about prevention," Ogawa says. "At the same time, it was a valid question, because it was something she was struggling with. I looked to the doctor in the room, and she said, 'You can answer it if you want.' I started sharing, saying that sometimes there are struggles, but He doesn't give us anything we can't handle. She was like, 'Okay, I think I understand.' Then the doctor piped in: 'In addition to having faith in God, you have to have faith in your medicine.'"

This was in reference to one of the major problems with keeping HIV/AIDS patients on anti-retroviral therapies in Africa-the prevalence of so-called "healing churches" that claim to cure the disease through the power of prayer. Doctors and religious missionaries must walk a fine line, allowing their patients to benefit from the hope and strength that come with faith while still encouraging them to be realistic about the scientific efficacy of anti-retroviral drugs.

It was a role, however, that Ogawa relished taking on. "I was in a position where I really didn't know what to say, but it was a really powerful position to be in, to try to answer these questions," she says. "It's a question we all struggle with: Why is there bad in the world?"

This question was often on the minds of all four volunteers as they were introduced to the sorry state of medical care across the region. Much as Ogawa and Patrick had been taken aback by the conditions at the public hospital in Botswana, Garrett and Halton were shocked to learn that cancer patients in Swaziland had almost no recourse to treatment. After a visit to Good Shepherd Hospital in Mbabane, Garrett wrote of the experience on her travel blog,

"Some of these people have absolutely no hope and are sitting in these beds just waiting to die. Teresa, as an oncology nurse, was especially frustrated with the situation.  The country, the WHOLE country, is allowed 1kg of morphine per year and essentially no hospice care... There is essentially no oncology department here-no radiation, no access to chemo, nothing but a scalpel and last ditch efforts to amputate the affected organ."

Garrett and other students expressed newfound gratitude for the high level of care they'd taken for granted in their home country.

Far from being discouraged, however, the student volunteers were in fact energized about the prospect of pursuing careers in international health. For Garrett, it was the example of her mentors and new friends that made the difference. "The more I hang out with these doctors who aren't very old, as in their early thirties, and are super funny and cool and pretty and awesome, the more I can see myself doing this," she wrote on her blog.

Halton echoes her sentiment. He adds that, as an undergraduate pre-med, with an entire decade of training standing between him and a medical practice, he had begun to idly wonder whether medicine really was his calling. This hands-on experience, however, had him waking up each morning excited to go to the clinic and make a difference. "It's something I could definitely see doing for the rest of my life," he says.