People cling to what is familiar and their own, and that basic human-nature tendency is no different here. We presented the adherence charts to Tsepong Clinic, a clinic that dispenses ARV medications. The doctor we spoke to reacted very positively and called in her nurses who typically are the ones who measure adherence. These nurses were less impressed and showed us their technique for measuring adherence.

When a patient opens a medication bottle, the date is immediately written on the lid. When the patient comes to the clinic, the nurse sees this date and finds the corresponding date on this chart. Based on the particular dosage and when precisely the patient took the first pill (AM or PM), the nurse determines the number of pills that the patient should have left. The pills are then counted, and if the count is within 3 pills of the number in the chart, the patient has good adherence. Every day, these nurses make a new chart like this one, and though we explained that the generalized adherence chart could potentially save them a lot of time, they have a system that works for them and do not see any reason to change.

They did recommend that we introduce the charts to a clinic where there was not already a system in place for adherence. In the meantime, we traveled with Dr. Oden, Dr. Machen, and Lauren to Maluti Hospital where we had a great meeting with Dr. Hurlow, the hospital’s (and district’s) medical director. He saw potential in some of the BTB technologies and welcomed Eric and me to fix broken medical equipment throughout his hospital. Shortly thereafter, we were reassigned to work at Maluti Hospital in Mapoteng. We wrapped things up at Motebang Hospital on Monday, gathering feedback and leaving behind a handheld pulse oximeter for the Casualty/ICU and a VeinLite adult transilluminator for the Maternity ward. On Tuesday, we packed our things, thanked LeBoHA for all of their help at Motebang Hospital, and arrived at our new home in Mapoteng.