The Last Report (in which I discuss the conference and finally get sad about the end of the Watson)

It’s September 1st, and the cold morning air seems to be celebrating the beginning of fall. I’ve ducked into a nearby café for a warm coffee, and it turns out to be Scandinavian-themed, with surprising authentic kanelbullar and phrases written in Dutch that look almost identical to their Swedish equivalents. This will be my first fall in the US not consumed by back-to-school sales and the idea of new classes; by this time a year ago, I had already been living in Sweden for over a month. I can’t help but feel a pang of nostalgia for that time, a fitting emotion to go along with the bite of cold weather.

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All the 2016-17 Watson Fellows. I am honored to be standing here with such an honest, lovely, and inspiring group of people.

My last reflection for the Watson year is due today, so I am sharing it here (fair warning – it is a bit longer than the other quarterly reflections). This will be the end of this blog, so I want to thank everyone who followed me and supported me throughout the year. Knowing that so many people were reading the blog is what kept me writing, and I love you all for that. Thank you.

Watson Final Reflection (Quarter 4)

New York City is a lot kinder than I remembered. After years growing up in Manhattan, I expected to come back to a place that seemed harsher and more foreign than ever before. But I find the city friendly and kind – maybe because I’ve been on the receiving end of so many kindnesses this year that I am more aware of the potential of kindness in everyone. Or maybe it’s because my Watson year was difficult and full of the unknown, and the mere fact that New York is familiar, with signs in English, makes it seem easy. Maybe it’s because I was so worried I’d be disillusioned with New York and the US as a whole when I returned, and it turns out that I’m not. That even with all my strange new definitions of “home,” New York City is, indeed, my home.

In typical New Yorker fashion, I have been riding the subway nearly every day since returning to the city. When I’m on the trains (which look the same as they have my whole life, for better or worse), I often feel like time doesn’t exist; that “now” could be 5 years ago, or 5 years in the future. I wonder if the Watson hasn’t happened yet or if it’s already happened many years ago. This sense of warped time is partially due to the nature of being in transit, frequently traveling amongst strangers – a state I’ve gotten quite used to. Riding the New York City subway is familiar, as something I’ve done all my life (certainly “pre-Watson”), but it is also very similar to much of my movement on the Watson.

This is all to say that I am still processing the end of the Watson. I avoid saying “since I’ve come back home…,” because it implies some circular nature to the events of the past year. The Watson was far more than a simple trip for which I left home only to come back a year later. It was a step forward, a continuation of the life I have been living, and a year in which I had many homes. Though I am in the same physical city now as I was before the Watson, the world has carried on in the meantime, and I feel different, older. So I haven’t exactly gone back.

The Watson conference was a wonderful place to start processing these strange feelings. Meeting my cohort of Watson Fellows was an emotional experience that far exceeded my expectations. For some reason that I can’t understand now, I was worried that it would be too overwhelming, with too many strong personalities in too short a time. But as the Watson Foundation promised, the few days we spent together felt more like a warm family reunion than a conference. The other Fellows, with their eloquent and thoughtful presentations, were able to describe emotions that I have felt deeply throughout the year but have been unable to voice. As one Watson Fellow put it, the conference felt like an opportunity to meet forty versions of the same passionate individual; a chance to see who we could have been if we had pursued different projects or chosen to live in other countries. Talking with the other Fellows, and discussing the more complex feelings and challenges we encountered this year, helped validate my experience and cement the Watson as a very real year.

The conference was also the first time in a few months that I let myself feel emotions again. About a month or two before I left Botswana, my last project country, I realized that I had been stemming deeper emotions, or at least compartmentalizing more than before. I thought it would hit me at some point that the Watson was ending, and that I would become overwhelmed and sad – but even just a week before my flight to the US, I didn’t feel as much of a sense of loss or even as much excitement as I expected. I said goodbye to my best friends in Botswana with more of a “see ya later” attitude than a real goodbye. I didn’t feel the depth of it when packing, or on the plane, or on my surprise 16-hour layover in Doha, even though I had the chance to meet up with my close friends from Qatar much sooner than expected.

Even at home, I didn’t feel it – not until the conference. Early into the Watson year, I happily realized that I was making more friends and forming deeper relationships than I ever hoped to, considering how little time I had in each place. But with all these lovely friendships came far more goodbyes than I could have predicted either. Fully feeling every goodbye, every loss, and every ending got harder and harder, only a few months apart each time, so I suppose I subconsciously learned to protect myself from those emotions. For that reason, I am glad that the Watson year is over. The lifestyle would have been become unsustainable. It was already emotionally exhausting, and now that I have finally let myself appreciate the end of the Watson and what I’ve lost, but also everything that I’ve gained, I find my heart quite a bit heavy. I feel like I’ve lived six full lifetimes over the past year, and that’s a lot to carry around, even though what I’m holding includes lots and lots of wonderful things. Maybe that’s why I can’t easily say that I’ve “come back” – because I can’t ignore that, while my one suitcase stayed the same weight all year, I feel heavier in other ways.

I want to remember these wonderful things, so I will put some of them down here, in writing. I don’t want to forget the way my Japanese host parents kept waving as I went through airport security for as long as it took for me to disappear from view. I don’t want to forget singing along to Beyoncé with project collaborators in Botswana on the 4-hour drive back from the most remote village I’ve ever seen. I want to remember telling my parents over Skype about going to a Japanese hot spring with my host mom, sitting naked in the steam with her and speaking broken English, and not realizing how weird that sounded until I said it out loud. I don’t want to forget the names of anyone I’ve met, or the looks and smells of the 50 different rooms I stayed in over the course of the year. I like remembering the little moments – wandering around Osaka by myself on Easter Sunday, meeting a group of young entrepreneurs trying to cultivate start-up culture in Nagoya, and having so many difficult conversations about Trump, racism, and Christianity with cab drivers in Botswana.

Of course, I will also remember what I learned from all of my meetings. In the last quarter, my project focused more on grand themes than individual, illustrative products. Though there were many times in Japan when I thought I had heard all the possible answers to my questions, and that I wasn’t finding new insights, I was still struck by the patterns that developed. By the end of my time there, I had a clear sense of the importance of collective culture, which favors large established companies over innovative start-ups. Along with the high aversion to risk that I noticed in Japan – probably part of the reason why Japanese life expectancy is so high – it becomes evident why there is not a high acceptance or early adoption of new medical devices in Japan, especially those that are invasive or require extensive testing.

In Botswana, the key factors that influence reactions to medical technology turned out to be the population size, the influence of the government, and the importance of community. The small population, a sparse two million in Botswana’s landscape, means that very little comes from Botswana or is made there. The head of the Botswana chapter of the South African Federation for the Disabled told me that, since Botswana is relatively well-off, foreign donors overlook the country compared to others in the region – even though the Botswanan government is constantly seeking additional funds for health crises. The fairly centralized government is one of the country’s largest employers, so it is a big part of Batswanan life. Instead of fast-paced start-ups or private companies leading medical technology innovation, all ideas and projects must involve the government to have a wide reach, which means the development of healthcare products gets slowed down by layers of bureaucracy. Furthermore, since Botswana doesn’t have a history of invention or a critical mass of people working outside the government, there are very few success stories to inspire new innovators – and much of the older generation looks down on the quality of potential “made in Botswana” devices. Luckily that attitude appears to be changing with new generations.

With fewer distinct medical technology projects and products to pursue in Botswana than in other countries, I had to adapt my approach. I enjoyed this change, as I was able to delve further into the examples I did see rather than having many one-off hourlong meetings with different companies. I followed one mHealth start-up in particular – a company that started in Kenya and offers a smartphone app for easy eye examinations – and watched it evolve over the course of two months. I interviewed the project manager in Gaborone, attended a preliminary budget meeting with the government at the Ministry of Health, and went into the field to talk to community health workers in rural villages about the start-up’s pilot program in one of Botswana’s school districts. It was fascinating to see this mHealth project from different sides and add the dimension of time to my understanding of their work – especially how working with the government, while necessary in Botswana, can slow progress.

Thinking about all the countries I visited, human-centered (ergonomic) design is absolutely a key factor in creating positive reactions to medtech. Of course, each country and each community is unique, and I found different answers to my questions in every project country. User-focused development processes, however, naturally account for most of these differences since they involve working and designing with relevant local groups. I also found other, less anticipated factors that were important in most countries, such as the presence of an innovative environment; the importance of finding and working with the key opinion leaders of a community, whether patients or doctors or village leaders; and the need for a good business plan or supportive finances, as the discussion of ergonomic design is a privilege that comes after establishing the affordability of these medical technologies. I learned that the slightest difference between countries could manifest in completely different attitudes to medical technology – and that different attitudes to medical technology, such as in Sweden and Japan, could lead to very similar health standards. The only way to know the impact of those small changes is to really know a country – its healthcare and technology, and the interplay of its politics, culture, and society – and that’s a process I truly enjoyed.

I wish I could say that I am inextricable from my project, as many Fellows are. I would love to draw a beautiful connection between the findings of my project and my personal development on the Watson. While both surely evolved, I do think of them as two separate progressions.

It’s hard to say exactly what will become of my findings this year, or my blog. I am happy to do all of this to wrap things up – the conference, this last report, closing up the blog – but I also don’t want to say that this all ties up in a neat little bow. It wasn’t the easiest year, of course, and not all of my meetings were thrilling or elucidating. Some were contradictory. Some seemed really exciting at the moment but turned out to be outliers or one person’s exaggerated experience. It’s difficult to package this up and neatly put it away, and I’m not sure I want to; all of my Watson year experiences are now part of who I am today, and that will stay with me. I think having this project has helped me think even more broadly than my liberal arts education. Observing so many “sustainable” design projects has inspired me to not only consider these elements in my future engineering work, but also to ultimately move from engineering to design.

As far as my own personal developments, I’m sure they will be evident more and more as the years pass. But one clear change is the fact that I enjoy and seek out alone time more than I ever have before. It sounds like such a small thing, but it does matter to me. I never needed alone time in college, and though I didn’t realize it at the time, that desire to be around people all the time was somewhat indicative of my own insecurities. I’m really fond of this change because it means that I am more comfortable with myself – happier spending time with myself and generally more confident in who I am as a person. I feel less reliant on others to give me advice and suggest how to be happy, and I have less of a need to fill my time with other people and other things. I have a new (or re-discovered) sense of completeness in being alone. I don’t want to lose my new appreciation of alone time now that I have the opportunity to be surrounded by people all the time. I want to make a conscious effort to keep that.

Similarly, I now feel comfortable going into situations without too many plans or expectations because I trust myself to deal with whatever might come up. I’ve gained more from being patient and seeing what will happen, knowing that either way things will be different from what I could predict and that I will be able to handle it anyway.

Another change I wish to hold onto is the way that this year has pushed me to be better. The Watson Foundation’s immense trust and investment in each year’s Fellows forces us to rise to the occasion, and I found myself particularly motivated to add something positive to people’s lives in order to be a worthy recipient of the grant. It’s impossible to ignore the privilege of mobility and the pangs of imposter syndrome that can accompany such a grant, and I think the only way to mitigate those feelings is to try to make some sort of positive impact while on the Watson and pay it forward in the future.

On the other hand, I’m sure some of the changes I’ve adopted this year are temporary, like so much about the Watson. I won’t always feel super comfortable living out of a suitcase, or be so used to hellos and goodbyes, and that’s okay. One of my favorite parts of the Watson conference was when we discussed what we want to take with us from the year as well as what we want to leave behind. I’m tempted to live the Watson lifestyle forever, and it was a good reminder that it’s okay to leave certain things behind from the year, to lighten that load a bit. Of course, there are many things I want to keep forever, such as that newfound appreciation of alone time, the ability to maintain steady emotions in the face of the most unexpected events and setbacks, and how to say “Cheers” in a few different languages.

For now, I feel like it’s time to redirect my energy to the US, where I do understand the culture and can act in my own context – at least for a little while. I haven’t yet figured out exactly what that will look like, and I’ve been getting impatient, likely because I’m still on the Watson time pacing. I got used to living full lives in spans of a few months, so it’s strange to me to have far more time than that to figure things out. But then I look at my Watson conference list of things I want to bring with me from the year, and the only word I underlined – amid self-confidence and minimalism and paying kindnesses forward – is “patience.”

All in all, I am filled with love and gratitude and humility after the Watson year and the conference. Thank you.

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Back {home}

It took me two days to get home. A 30-hour journey from Gaborone to Johannesburg to Doha to NYC turned into 48 hours when I ended up with a surprise layover day in Doha. It was the longest flight delay I’d had all year – so of course it happened on my way home. Luckily, of all the places to have a long layover, Doha was the best for me to end up. (Who ever guessed I’d say that?). I was able to go into the city and meet up with my good friends there for dinner before getting on my very last Watson flight. It was strange to see them again so much earlier than I expected to, but it was lovely, and probably a good opportunity to start thinking about all that’s happened this year and all the people I’ve said goodbye to.

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A view from Manhattan.

In the past couple days, I’ve had friends tell me to remember to take some time for myself and to resist talking about the Watson so much that it exhausts me. I’ve been catching up with friends and family almost every day, as well as discussing my year with hopeful future Watson fellows looking for advice. I feel like I’ve hit the ground running here since landing on July 20th, and without much time to process on my own, maybe I’ve stretched myself a little too thin. I suppose this blog post, being the first one I’ve written since arriving in the US 18 days ago, is the result of my finally taking the chance to breathe, sit alone, and process a bit. (This is basically a warning that this post is long, sappy, and disjointed, which is probably a good reflection of my Watson year anyway).

I’ve thought a lot about the definition of home this year, and I’m thinking about it even more now that I’m “back.” I am incredibly lucky and joyous to have two loving parents that are happy to house and feed me for free, for as long as I need, even when I don’t always want to talk about all that happened on the Watson or when I stay out late every night catching up with old friends. My parents moved within the city while I was gone, so when I left New York, we were living in a different apartment than now. Not only am I coming back to a physically different space (not that I am at all bothered by changing rooms!), but I am also coming back at a different time, as a changed person, to people and places that have continued to evolve while I’ve been away. This is why “coming back” doesn’t seem like the right phrase. I was in NYC a while ago; I did a lot of things in a bunch of other places; and then I traveled to NYC. This whole time, I was thinking that my arrival in NYC would symbolize the end of the year, things coming full circle, my return to home, etc. But I don’t feel those identifiable patterns, those neat circles or even the simple linearity of life. I still consider NYC to be home home, and I am very happy to be in the city, but coming back to the US at the end of the Watson feels more like a continuation of my travels rather than an ending or a reset.

Speaking of home, I stayed in 50 distinct rooms over the course of the past year! I slept on friends’ floors, in an ashram, in really fancy hotels, on a Russian woman’s couch in Sweden, in a Japanese capsule, in a bed shared with two other women, on a boat, in the guest ward of a hospital, and more. I thought it’d be a fun idea to keep track of them all throughout my travels. It averages out to be a new place for almost every week of the year, though of course I spent many nights in some places and only one night in other places.

Now, writing from Philly where I’m staying in a friend’s spare room, I find myself eager to keep the tally going, to keep counting these beds, because they weren’t just rooms I stayed in – they were micro-homes, they were real places that mattered to me all year, even if they were ant-infested or tiny or shared with a friend, and even if none of them were spaces I owned. I wrote down these places as though I would forget them, as though it was the location that made them home, or the host, and writing them down would remind me of the degree of comfort I felt in each place – but now I realize that the only constant of these spaces wasn’t that they housed me, but that I was there and made them home. By looking for home in all these places, I ultimately created home within myself. (I know how trite that sounds). But I thought I’d return to the US with a feeling that I had left bits of myself all over the world, and while that’s probably true, I feel slightly more optimistic that I can carry those bits with me anywhere I go.

Anyway! Here’s a little round-up:

  • Watson rooms: 50
  • Individual flights taken: 32 (including 13 domestic flights within India!)
  • Countries for my Watson: 6 (Sweden, Qatar, India, Singapore, Japan, and Botswana)
  • Countries I stepped foot in this year: 10 (the additional four are Denmark, South Africa, Zambia, and Zimbabwe)
  • Episodes of 30 Rock watched: all 138 of them, for the first time, over the first half of my Watson
  • Harry Potter movies re-watched: all of them
  • Swiss Army Knives lost at the airport thanks to poor packing decisions: 1
  • Pairs of shoes that I destroyed: 1
  • New pairs of shoes that I bought: 2
  • World Wonders seen: 2, the Taj Mahal and Victoria Falls
  • Swatties found abroad: 9, from the class of 2017 to the class of 1958 (!)
  • Best food I ate all year was in: Japan (incredible sushi, sweets, donburi, noodles)
  • Worst food I ate all year was in: …Japan (due to a delicacy of cod fish sperm I unfortunately ate 3 times)
  • Blog posts: 111, including this one
  • Notebooks purchased: at least 6, maybe 10
  • Kindnesses received: far too many to count
  • Compilation videos made: 1…

Before I started the Watson, a friend told me about “1 Second Everyday,” an app that allows you to take 1-second videos every day and ultimately compile them into a video that summarizes whatever time period you choose. I used the app all year, and here is the result:

[Video link is here for those who can’t see it. Also, I chose this song because it’s my favorite one to listen to when I’m on a plane that’s just about to take off].

This jumble of thoughts about the year may or may not get clearer as time goes on, but that’s enough for now. Thanks for reading!

Last night abroad

I leave Botswana tomorrow, and even though the date of July 18th has been in my head all year, it still doesn’t quite feel here.

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Some people in the departments of Computer Science and Engineering at the University of Botswana were interested in what I’d seen this year, so I gave them an informal presentation. Here I am with some of the attendees.

My trip home will take 28 hours, including a couple hours in Doha (hello again!) on the way to NYC. Thanks to the new electronics restriction on flights coming into the US from the Middle East, I was going to have to pack my laptop away in my checked bag for the whole trip (and worry about it not breaking – a nice welcome home from the new president). But just now as I went to check in with Qatar Airways, I saw that the ban was lifted, so that’s good news! Now I’ll be able to take my Kindle on the plane with me and finally finish the book I started ages ago (The Goldfinch).

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Wire animals at Princess Marina Hospital, the main public hospital in Gaborone.

I’ve been packing for the last time today, and I’m definitely ready to stop living out of my suitcase. I’ve somehow accumulated a extra bag’s worth of stuff over the year – I packed so tightly when I left that I didn’t leave room for the few clothes, small trinkets, and many papers that I would acquire throughout the year. My packing right now is a bit sloppier than most of the times I’ve packed this year, but this time I just have to get my stuff home instead of setting up someplace new.

Most of what I brought with me is coming back, except for pants I managed to rip yesterday (oops) and the travel quick-dry granny panties I unceremoniously tossed a few days ago. A few other things got tossed and replaced throughout the year, but for the most part I’m very happy with what I packed.

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I went to a cafe in Gaborone that had this framed Swedish bill (it’s 100 Swedish kronor, about $12). It completely took me by surprise, and all of a sudden I was thrown into a bunch of memories from last fall. I feel like this will be how I know that the Watson has been real, that I’ve really been to these places and left little bits of myself in them – when these random reminders appear out of nowhere and pull at my emotions and my memories.

Today is President’s Day in Botswana, and as presidents are apparently very revered here, everything is closed. Botswana will stay quiet until Wednesday (after I’m gone), and the one meeting I had scheduled for late last week was canceled because the doctor started his holiday a bit early. It’s been nice to slowly wrap things up and not worry about any more meetings, but now I’m getting antsy to go home (I wish, at least, my Zumba class were open today, or the cafe where I have a free coffee that I’ll never redeem). The journey home will be long enough that I want to get it started!

I’m very excited to finally come home and return to NYC after the longest continuous time I’ve spent away from the city. I’m sure the end-of-Watson feelings will kick in a bit later, maybe on the plane – I’ve said a lot of goodbyes these past few days without actually feeling them. (I think that after a certain number of goodbyes, you just go through the motions because it would be too emotionally exhausting to really feel them all. That will all sink in eventually, too). For now, I’m excited to have one last crazy long journey and go home to my friends, family, and of course, the dog.

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Of course, this isn’t my dog – this is Butters, one of the dogs at the Airbnb where I’ve been staying in Gaborone. He’s a goofy troublemaker.

P.S. This is my last post written from abroad on the Watson, but not my last post on this blog – I’ll keep writing for a little while longer to cover coming home, the Watson conference, and the final Watson report.

Health post: Vision tests & witches afoot

Peek Vision is a health startup aimed at improving access to vision services and eye care. Their main product is the Peek Acuity mHealth solution, a smartphone app that allows anyone to conduct a vision screening in a few minutes. They have a few other products as well, all of which contribute towards their goal to perform vision screenings (particularly for schoolchildren) as well as make a real impact by providing eye care and/or glasses for those who need them.

Peek was founded by a London-based PhD candidate, piloted in Kenya, and has had a chapter in Botswana for a couple years (here is a great TED Talk by Peek’s founder). Last year, Peek partnered with the Botswana government to perform screenings in 49 schools, rural and urban, in the country’s Good Hope district.

I interviewed Maipelo, the project manager of Peek Botswana, to learn more about the screenings. She traveled to many of the schools involved throughout the screening process and personally helped train local healthcare workers so that they could use the app.

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A typical visual acuity “tumbling E” board.

Since the app is free, I downloaded it myself. The app acts as a replacement for the “tumbling E” boards typically used in visual acuity tests – children are supposed to tell screeners which way the “E” is pointing (for example, an “E” in the usual orientation is pointing to the right; a backwards “E” points to the left). The typical boards can get lost or damaged, and the pattern of Es can be memorized by children (a sequence of up, right, down, etc). The Peek app addresses those problems while also keeping track of anyone who fails the test for follow-up purposes.

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Maipelo with the Peek Acuity app.

When you first open the app, it brings you through a tutorial to show how the screening should go. The screener needs to stand exactly two meters from the student (or whoever will be screened), holding the phone so that the screen faces the student at eye level.

My favorite part about the Peek Acuity app is how the actual screening goes – the screener never needs to look at the app while the student is watching the screen. When an E is displayed on the screen, the student points in the direction of the E. The screener then swipes the phone screen in the direction that the student is pointing and never needs to look at the E. The screener doesn’t need to know if the student gave the correct answer; it is automatically recorded by the app. The Es displayed on the screen continue to change direction and size, adjusting to the student’s performance. If the student can’t see the E well enough to guess, the screener is supposed to shake the phone so that a new, slightly larger E appears.

After about two minutes, the phone plays a sound to indicate the end of the screening. The screener then looks at the phone and sees the result (for example, “0.8” for a student with quite poor vision). There’s also a built-in simulator that displays how blurry a chalkboard would look to someone with 0.8 vision, for example, so that the screener truly understands the numerical result. The simulator feature also ideally builds empathy for students who have had undetected vision impairments – students who struggle in school and often get written off as being lazy or naughty by teachers who assume that they can see perfectly fine. (This is true for hearing as well. The HearScreen people in Pretoria described hearing problems as a “silent epidemic” because kids with such impairments often go undetected and are treated like bad students when they don’t do well in school).

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A screenshot from the app showing the vision simulation feature.

Maipelo told me that, for the most part, the screeners and the students responded well to the Peek screening. Everyone is excited when they see the app, she said; less so when they are told to use it and realize they have work to do. Regardless of how fast and easy the screening process is, it’s still work, especially when screeners work all day long checking hundreds of schoolchildren. Also, Maipelo said, those who were less comfortable with the phones would take longer to input data. Even if the difference is a minute and a half instead of, say, 45 seconds, that adds up with so many screenings per day – and it can get frustrating for the less tech-savvy screeners.

I also asked Maipelo about the follow-up process. When Peek Acuity indicates that a child has impaired vision, the app prompts the screener to enter their contact information. The app then automatically texts the child’s parents with the follow-up details – where they should go to meet with an eye doctor and when. That’s when the children would get glasses if they needed them.

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One of the Peek Botswana employees demonstrates a screening with the Peek Acuity app.

That is where it could get complicated, Maipelo told me. Even though all the parents had a positive reaction to the idea of medical technology, she said, they never liked to hear that their kids had an impairment and needed a follow-up. People only question the technology after it illustrates a problem, she said. Even if the app just says that their child needs glasses, parents immediately respond negatively to anything they interpret as a “medical issue.” Maipelo said that some people believe such problems are curses or bewitchments. “Bewitchments?” I echoed. Yes, she said, people grow up hearing about witches.

This isn’t the first time I’ve heard about witches in Botswana. It seems to be a traditional idea that witches are afoot, causing problems or punishing people for various reasons in various ways. I think when there is a lack of awareness about these things – not knowing how common and remediable vision impairments are, for example – all medical problems could seem as serious as a witches’ curse.

Another local later told me that some people in Botswana have the misconception that glasses will actually worsen vision. If a well-sighted person looks through someone else’s prescription glasses, of course the view is distorted; this apparently leads some well-sighted people to believe that glasses are harmful. Also, people with glasses never stop needing glasses, needing stronger prescriptions as time goes on. Both glasses and crutches are medical devices, but crutches help you get to a point where you don’t need crutches any more; glasses stay forever. Apparently this, too, contributes to the misconception that glasses degrade vision. Of course, most people in Botswana do know that glasses help, but of course it would be best if everyone (especially the more skeptical parents) were on board.

Another interviewee phrased it like this: “In our culture, everything should be normal.” Everything should fit the status quo. People don’t accept the abnormal; they say it’s the work of witches, he said. (And there they are again). Unfortunately many impairments, including poor vision, aren’t normalized, so everything (even the need for glasses) gets labeled as “abnormal.” I’ve heard this in general, too – many people have told me that fitting in and maintaining the status quo is very important in Botswana, which I think makes sense with the neighborhood lifestyle here. In terms of medical problems, it all boils down to awareness and the importance of normalization. If more people wore glasses and it was seen as normal, there would be less stigma against vision impairments, and it would be easier to convince people to treat vision problems less like serious, scary medical issues.

I’ve really enjoyed getting to know Peek Vision throughout my time in Botswana. Including my interview with Maipelo, I’ve had many interactions with Peek – I’ve talked to people involved in different aspects of the company; I sat in on a government meeting where Peek pitched a budget to the Ministry of Health for a potential national rollout; and I’ve met health workers who participated in Peek screenings in very rural areas. When I started my project, almost all of my meetings were one-offs. I had hourlong chats about many different devices and technologies, definitely seeing more breadth than depth. There haven’t been so many examples of medical technology to explore in Botswana, so I’ve tried to dig deeper into the examples that are here, and it’s been cool getting to see Peek Vision from different sides. These diverse vantage points have also illustrated different challenges of getting an mHealth project underway in Botswana – such as how important hierarchy and social niceties are when dealing with government officials in the capital city, or how screeners in rural areas don’t think about how easy or difficult the app is to use if they’re not getting paid to do the screenings. I’m really grateful to Peek Vision for all that they’ve shown me here in Botswana.

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This is Peek’s hardware product, Peek Retina. It wasn’t part of the school screenings, so it’s hard to talk about user responses, but I think it’s very cool. It’s a small device that can fitted over a smartphone camera for retinal screening, which can detect diabetic retinopathy and other issues.
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I had my pupil dilated to be the guinea pig in a hands-on Peek Retina demonstration. Here, someone is trying to screen my retina with the Peek device and a smartphone, with an optometrist looking on.
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Always a fan of cool hardware!

 

 

Pretoria

As the drizzle started to fall on me in Pretoria, I thought about how neither I nor the rain was supposed to be there. I had ten days left on the Watson (six, now), and I had decided to go to Pretoria, South Africa, to meet a company there for my project. It’s winter in South Africa at this time of year, and in the northeast, where the capital of Pretoria is, that means dry season; rain is only supposed to fall there in the summer.

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This is at a day care center in Mamelodi, ZA. I’m standing here with Charles, who helped HearX organize screenings for the children.

I wasn’t supposed to be in Pretoria because South Africa is not one of my Watson project countries. Beyond that, I’m technically not supposed to go there because I’ve already spent so time in South Africa, having studied abroad in Cape Town for 5 months my junior year of college. But Pretoria is on the other side of the country, far closer to Gaborone than to Cape Town, and I figured it would be worth breaking the rules for just a few days to see something relevant to my project (especially since I’ve nearly exhausted my project opportunities in Botswana by this point).

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The Voortrekker Monument of Pretoria. The monument and enclosed museum commemorate the Voortrekkers, pastoralists who traveled across South Africa in the “Great Trek” of the 19th century.
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At the Voortrekker monument.

I arrived back in Gaborone last night after another 6-hour bus ride across the Botswana-South African border. Earlier in the Watson, I would have asked for permission ahead of time for this short weekend transgression. As I was visiting a monument in Pretoria enjoying the rain, weather I hadn’t felt in a long time, I realized that I had reached a new level of confidence – the confidence to make that judgement call and know, on my own, that it was still within the spirit of the Watson and still good for my project to break the rules just a little bit – a level of confidence that I could only have now, at the end of the Watson. You can only properly bend the rules once you’ve lived within them and respected their existence.

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On the steps of the Voortrekker monument.
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Looking down from the top floor of the monument.

Of course I have been making my own decisions all year, but always within the bounds of what had already been approved for me – going to Pretoria was a decision that I made on my own basis of what was appropriate, confident that it would be worth it. I used to think “confidence” was simply being comfortable in yourself and your abilities. But that sort of confidence is so easily confused with arrogance. There’s a deeper confidence, I’ve found, that lies within the humble acceptance that you’re making it up as you go, that there is a lot to learn, and that you can still deal with everything in life anyway. The confidence of knowing yourself and having that be enough – not needing anyone or anything else to move forward. The confidence to be able to talk to anyone and not be better than anyone else.

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I wasn’t too interested by the museum in the Voortrekker monument, but I loved the architecture of the building and all these vantage points that led to geometric views.

Anyway, before this gets any sappier, I’m glad I went. My project contacts in Gaborone were the ones to suggest the trip to meet with HearX, an e-health start-up that spun out of the University of Pretoria. HearX’s main product is HearScreen, a mobile health solution that facilitates simple hearing screenings. With the HearScreen app and approved headphones, the screener plays 3 different tones in each of the listener’s ears. The listener is supposed to raise a hand when they hear a sound, and the screener notes whether or not the listener responds to all the tones played. At the end of the two-minute screening, the app alerts the screener if the listener has a hearing issue and needs to be referred to an audiologist. The audiologist can then determine why the listener failed the screening (HearX told me that the most common cause is wax blockage, a simple problem to fix) and if they need to go to the next step, such as receiving a hearing aid.

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Lelanie (left) and Charles (right) at the Mamelodi day care center. Charles is holding the HearX case, which includes everything needed for a screening – mainly a smartphone with the HearScreen app along with the specific headphones.

I met the HearX people at the Innovation Hub, a set of offices for start-ups in Pretoria. From there, I went with Lelanie, a social worker at HearX, to Mamelodi, a nearby township. That’s where we visited the day care center and met with Charles, a local contact who has helped HearX do school screenings for children in the area. Charles brought in a young boy to show us how the screening worked, and he explained everything to the boy in his local language. I find that these “local ambassadors” are often key for encouraging the adoption and use of m-health and e-health products; Charles is clearly great with kids and made an effort to make the little boy feel comfortable. Lelanie also told me that the kids get more excited about the hearing screening when the screeners tell them that they have to wear the big headphones “like a DJ.”

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Charles had me act as the screener for this trial run. The app was really easy to use, although I think I went through the screening a bit too quickly! 

I sat behind the kid we were screening so that he wouldn’t be influenced by my actions. Lelanie and Charles told me that when the HearScreen project started, they realized that kids could just watch the screeners using the app, raising their hands when they saw the screeners tapping the phone – anticipating the tone rather than actually responding to it. Otherwise, they haven’t had any issues. HearX is planning to expand into Botswana, which I think would be great. The main challenge there, as I’ve mentioned earlier, is that they’ll have to integrate with the Botswana government to an extent that they don’t have to with the South African government.

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The city of Pretoria from afar.

Victoria Falls

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Pretty amazing. With the “rain” coming from the rushing water misting up over us, plus the sun in the sky, we kept seeing rainbows all over the falls.
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On a tiny plane from Gaborone to Kasane.

Okay, I did it. I went to Victoria Falls. It was a pretty touristy weekend, but so worth it – the falls are beautiful. I went with 3 other women, and we did it all in 48 hours: flew to Kasane, the north-easternmost town in Botswana where we stayed for 2 nights; saw animals in the national park from the water; day-tripped to the Zimbabwean side of Victoria Falls; and flew back home to Gaborone the next day. I think it was the best way to do the trip, at least from the Botswana side. If I ever go again, I’ll definitely want to see the Zambia side of the falls (Vic Falls is a bit like Niagara in that it can be viewed from one of two countries).

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My first time seeing a hippo in the wild! And that’s the Botswana flag in the background.
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Elephants on the water. Chobe must be the greenest area in Botswana.

Kasane is essentially a tourist town, a name for where all the lodges line up along the Chobe River. The Chobe National Park, known for its wildlife, is one of the main tourist destinations in Botswana – Gaborone certainly isn’t (very few travelers hang around Gabs, as I have, but of course I’m not really a tourist). It’s very close to the borders of Namibia, Zimbabwe, and Zambia.

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Sunset on the Chobe River.

To get to the falls on Saturday morning, we took a van organized by the lodge with other travelers. First, we passed through the Botswana border patrol and got departure stamps in our passports. Next, we arrived at the Zimbabwe border patrol, where we had to get full-page visas to enter the country for the day (it’s actually really cool-looking!). This was quite the experience. We were told to leave our passports at the counter in this tiny office and walk away from them – never a good feeling – and leave our driver/guide to pick them up and bring them back to the van. After 20 minutes or so, we got them back…all except one. One German girl from our van didn’t get her passport back right away. Somehow it had ended up with a Korean man in a van ahead of us, and it took a long time to sort that out! A lot of tourists were coming through that border post.

My group was curious about the Zambia side of the falls. We saw a poster for a one-day Zambia-Zimbabwe visa and asked our guide about it. “Can we go to Zambia today too? We heard the falls are beautiful from that side.” “No, just Zimbabwe.” “But look at this poster!” “Well, we don’t bring people to Zambia.” “Why not?” “There won’t be time.” (It was clear by this point that our guide had a plan he wanted to stick to, and we should not try to deviate from that plan. I would have loved to do the day trip without a guide if possible, but this was the way to do it). “But we have all day – can’t we just pop over there?” “Uh…they won’t let you.” “Why not?” “You can’t re-enter Zimbabwe from the Zambia side if you don’t have proof that you’ve gotten the yellow fever vaccine.” Well, from my travels in South Africa, I did have the yellow fever vaccine, and I even had my yellow card with me to prove it because I keep it with my passport. So of course I took it out. “Well, I actually have that right here!” He gave me a look that clearly said “No.” I eventually walked out to the van and waited for my passport.

As it turned out, we did go into Zambia, but only for a few minutes and very unofficially (no passport stamp). When you get to the falls in Zimbabwe, there are two parts: the main part where you enter the Vic Falls park and walk along the falls on the Zimbabwe side, seeing them from many different viewpoints, and then a short distance away, a big bridge for the activities (bungee jumping, zip-lining, and so on). The bridge is beautiful, and it actually does go from Zimbabwe to Zambia, though for the activities you only spend a few minutes on that side. Two of the girls I was with wanted to go bungee jumping, so we went to the bridge first before officially seeing the falls. We heard the falls in the background and saw part of them from a distance, which built up our anticipation of the falls.

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The bridge from the Zimbabwe side. Someone is bungee jumping off it in this photo!

Bungee jumping looked a bit too scary for me, as well as way out of my budget, but I did go zip-lining with the other person in my group! It was probably the most extravagant thing I’ve done on the Watson so far, but it was a blast. And now I can say that I zip-lined from Zambia to Zimbabwe – so that seems pretty worth it.

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“Beware – Hazardous Drop Ahead.” You can’t tell from the photo, but we’re both freaking out at this moment!
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I realize this photo is super corny but I was having a blast. The view was beautiful.

Finally, after our short stint in Zambia, all our activities, and lunch, we went to the Victoria Falls UNESCO World Heritage Site in Zimbabwe. We entered the gate and saw two paths, one to the right and one to the left. Someone told us that they started from the left but that both paths lead to the falls. We took the right.

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We followed the tree-lined path for a while and eventually stumbled upon the falls, mysteriously shrouded in white mist. It was cold and damp, and the mist rose forcefully up from the falls and rained back down right on top of us. It was a sunny day, so we saw a lot of rainbows. As we moved further along the path, we got closer to the falls – and we got soaked! The water was rushing quickly and loudly and caused enough rain to drench us in minutes. It’s a wonder we were still able to take photos with our cameras and phones without damaging them.

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One of the Victoria Falls viewpoints on the mistier side: Horseshoe Falls, not too far from Rainbow Falls (the fog was too heavy for me to get a picture of that sign!).

At one point the fog lifted a bit, and we began to grasp the immensity of the falls. We couldn’t even see the bottom of the gorge where the water was falling. As the only four people standing at the edge of the falls, we were cold and dripping and giddy with excitement.

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Completely drenched at Rainbow Falls!
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Beginning to see more of the falls…

We then doubled back on the path to go towards the other end of the falls. At each viewpoint, the falls looked more and more beautiful. We realized we went through the whole thing backwards – if we had taken that left at the start, we would have begun with the traditional (and dry) view of the falls, and then ended at the misty Rainbow Falls viewpoint, where we started. But I’m so happy we did it in reverse. We got to see the mystery of Victoria Falls slowly unfold in front of us, beginning with our first glimpse from far away on the Zimbabwe-Zambia bridge. We got to discover Vic Falls bit by bit throughout the day until the full beauty of it was finally in front of us. If we had started with the classic, full view, we wouldn’t have had that slow, exciting build-up – and we wouldn’t have been so happy about getting soaked by the falls at the end when we couldn’t even really see them.

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The largest falls in the world in terms of water flow!

All in all, it was a really great trip, and I’m so happy I got to go. I want to see the rest of the natural world wonders now! I was also really content to return “home” to Gaborone. I was talking about the definition of “home” with my friends after we got back. How long do you have to stay somewhere before you can say that you lived there? What does it mean to have a home? One idea was that you live somewhere if you would give a friend that address so that they can write you a letter. Another idea was that when you buy groceries and cook for yourself in a place, you’re living there. The amount of time you spend somewhere definitely matters, but so does your relationship to that space.

I realized that my idea of home is a place that I leave and come back to. The weirdest aspect of traveling on the Watson is the way that it’s sustained; you hop from one strange place to another without ever going back to your true “home.” Most people travel in distinct trips, from home and then back. When I went from Stockholm to Doha and then onto Mumbai, I didn’t feel like I lived in Stockholm. I never called Doha “home.” But then I used Mumbai as a base while in India – I traveled out to other cities and states in the country but usually returned to Mumbai in between. By the end of my time in India, Mumbai felt like home. I could leave stuff there and return to it, just like a regular trip-taker; I created the illusion for myself that I wasn’t living the sustained nomadic lifestyle of the Watson, where you take everything with you every time you move. I’m not sure if any of that makes sense. But the point is that, on Sunday when I was flying back into Gaborone from Kasane, I felt like I was coming home.

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Probably my favorite view of the falls, right at the end.

The Tropic of Capricorn

We stopped at the Tropic of Capricorn on the way back from Serowe. Serowe is a small town in Botswana, and I traveled with a group to visit the hospital’s vision center there and learn about the process of eyeglass making. The Tropic of Capricorn is a latitude in the Southern Hemisphere, and it traces the southernmost circle on Earth where the sun’s rays can hit from directly overhead (any further south, they always hit at an angle). The northern equivalent is the Tropic of Cancer.

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A Capricorn myself, though not a big astrology person, I was pretty excited to be there. It’s marked by a simple street sign and a small monument – a rock with a vertical metal rod on top. Every year, at 12:12pm on the winter solstice (December 22; summer in this hemisphere), the sun shines directly down onto the rod. The light beams straight through the hollow rod and onto the rock, creating no shadow. Since we weren’t there at the solstice, of course, the rod cast a shadow.

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Here is the rod with a description on the rock below.

That morning, we had visited the Vision Centre, an area of the eye health ward in Serowe’s hospital. Equipped and funded by a British charity organization, the Vision Centre includes all the facilities necessary for cutting glass lenses to make custom eyeglasses. That’s where we met Michael, a technician who makes 10-15 pairs of glasses a day. He walked us through the process of cutting a lens, showing us the 5 or so machines involved.

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This is Michael, about to cut the circular glass lens he holds in his hands. The many machines he uses to do so are behind him.
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A wheelchair in the Serowe hospital fashioned out of a plastic lawn chair and common bicycle tires. A worn-off sticker shows that they were donated by some charity or NGO (perhaps American?) but it’s too faded to read the name.
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The foyer of the hospital.

In Serowe, and every time I’ve been somewhere new, we did multiple rounds of introductions and hellos. Every day, I think about how important social norms are in Botswana. I think I’ve touched on this before – there is a well-established code of social interaction here, something like that small-town friendliness in suburban America. It’s at the same time my favorite and least favorite thing about Botswana. Everyone says hello (dumelang!) to each other on the street, even strangers, often continuing to ask “How are you?” and the like. It’s considered very rude to begin any interaction, even if you’re just purchasing stamps at the post office, without these pleasantries. I think it’s lovely, and in a capital as small as Gaborone, it’s important to be kind to people when you might be speaking to your brother’s neighbor or your friend’s mother. As a result, the Batswana seem far more socially adept than many people I know.

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If spaces could talk…what would they say? I see this almost every day in Main Mall, Gaborone.

At the same time, it drives me crazy. It slows things down. No one is ever in a hurry – to appear so would be rude. I grew up in Manhattan, where I perfected the style of speed-walking that signals “don’t talk to me.” It’s also a safety thing. Every time a random man or cab driver or stall owner calls “Hello” to me on the street, I’m conflicted between respecting Batswana culture and wanting to ignore it, as I’ve been trained to ignore any attention from random male passers-by. Usually I respond with a curt “Hello” in return and promptly ignore any ensuing conversation. On longer walks, I listen to podcasts or music, and hope that the earbuds serve as a defense against being rude – I smile at the people around me while conveniently being unable to hear them.

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More street art from Main Mall.
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A traditional Botswana meal from the food vendors seen in the background. For 15 pula ($1.50), you can get this little plate with your choice of starch, meat (seswaa is traditional – pounded beef), and veggie sides (I like the sauteed greens and mashed butternut).

Anyway, I’m off to Victoria Falls tomorrow, which I’m excited for since it’s considered one of the 7 natural wonders of the world. I’m hesitant as well because it will be a very touristy weekend, outside of Botswana, with other American travelers – none of that is very Watson-y. But it’s only a two-day trip, and I missed the opportunity once before (I could have gone when I was studying abroad in South Africa for 5 months), so I didn’t want to miss it again. I’m also feeling quite good about my project here. I’ve met with a few different groups by now, and a couple days ago I met with the only local medical device start-up in Botswana, so that was great. Plus, it’s been too long since I’ve taken a flight! (well, a couple months).

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Food vendors by the side of the road for watermelon, nuts, and crunchy worms (lower left).
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Advertising in Gaborone.
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The flower wall at Sanita’s Tea Garden, a plant nursery and café in Gaborone.
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More from Sanita’s.