"Ah Modimo wa me"

The pharmacist from the travelling ARV dispensary muttered “Ah, Modimo wa me” as yet another patient tried to explain why she had missed so many pills and I thought how funny it is the way that some phrases do in fact directly translate. “ Ah Modimo wa me” means “Oh my God” and seemed to me a pretty apt expression for the situation. I was sitting in on the regular Wednesday dispensation of ARV (anti-retroviral) pills for HIV patients from Kachikau (the village in which I’m staying) and the four other surrounding villages. The pharmacist, his assistant, and the several boxes of drugs that accompanied him were coming from Kasane, about an hour’s drive away on a dusty corrugated dirt road.

The first woman to come in had missed one of her pills since her last visit to the pharmacy, and after she sort of giggled out this admission, the pharmacist gently chided her, joking in between, that she really must take these pills. I was surprised at how light-hearted the interactions appeared, given the gravity, at least to me, of what they were really talking about. The routine followed about the same script for the next patient, but when the third patient walked in with a container rattling full of untaken pills, the tone in voices suddenly changed. The kindly Malawian pharmacist suddenly was not smiling any more, and the translator (for those who spoke only Setswana and no English) sat a bit more forward in her chair. He had missed four pills since his last dispensation, and this meant that his body could have built up resistance to the drugs (much the way we are always reminded to finish a prescription of antibiotics, even if we start feeling better right away). If this was the case, then they would have to move him from Line One drugs to Line Two, the pharmacist explained. And this was not good, he said, leaving out the explanation as to why. But what was clear was that missing pills on a regular basis was like shooting oneself in the foot. WHY, I wondering, would you not just take the damn pills on the proper daily basis?? How hard could it be, especially when the stakes were so high??

This question was answered in part by the next patient, a woman who looked about fifty but might have been barely forty, and skinny as a rail. She had been skipping pills too, and this time the pharmacist wanted to get at the cause of her neglect. Why wasn’t she taking her pills at the prescribed hour of the day, each day? Well, for starters, it came out, she wasn’t working and neither was her daughter, her only family member staying with her. So it was hard enough just to get food to eat, let alone keep track of her medical schedule. Second, the watch she had been using to ensure that her pills were taken at the same time each day had been taken by a family member to Francistown (about 500 km away). So she had no way, except roughly by the sun, to know when to take the pills. On top of that there was some debate as to whether the woman even would know how to read a watch, if the clinic gave her one. And here I have to admit that even though I have spent a fair amount of time in Botswana, I was stunned. I honestly had never really thought about these seemingly minor details that become gargantuan when a person doesn’t have access (or enough money) for basic items like a watch or clock. I was reminded of the feeling I had after reading an article for Louise’s class about some of the overlooked reasons why homeless people have a hard time getting a job—one factor being that what would you do with your cart, holding all your possessions, while you walked inside for an interview? What if it got stolen? The feeling I had then, and which I had after listening to the watch discussion at the clinic, was one of guilt mixed with shock and wonder for never having thought of these logistical issues, for always assuming there had to be larger more “weighty”, so to speak, explanations for such social phenomena. It was an eye-opening experience today, that is for sure. And while I’m not exactly sure how it relates to my intended dissertation topic (natural resources? the environment?), it certainly was a significant introduction to village life in the Chobe Enclave.