Spice Rubbed Steak and Egg Avocado Toast

I can’t believe I’m already halfway through my pediatric HIV elective month in Africa! (Follow on instagram for frequent updates!)

Botswana has the 2nd highest HIV prevalence in the world at 25%, which is a shame since it’s quite a stable and peaceful African country. The government has mounted a huge campaign, and anti-retrovirals are free for patients, paid by the government, grants, or international aid. I’m considered an “intern” here, so I have a lot of autonomy here which I love – the best way to learn something is jumping in and doing it. I write orders and prescriptions, decide what labs and drugs they need, and make the plan (after checking with an attending of course).

I even have medical officers (their residents) follow me on Mondays so I train them in clinic. It’s really weird that as a medical student I’m actually teaching residents, lol, but we are basically equals here.
What’s working at a clinic like in Botswana? Well, the patients are sooo much smaller and skinnier here. Too many 18 or 19 year old boys weighing less than me … and I’m a petite 5 ft 1 in Asian girl! I’ve had patients underweight by more than 5 standard deviations! O_O’

Most are fairly normal on physical exam apart from the small size, but sometimes findings can be impressive – skin (herpes zoster and chicken pox scars, molluscum warts, pruritic papular eruption), heart murmurs everywhere from anemia/ malnutrition, significant intellectual disability from HIV encephalopathy, the most textbook perfect chronic lung disease signs (clubbing, barrel chest) in a boy living on an O2 tank for 16 years, side effects of years of HIV drug use (black nails, breast development, fat redistribution), scars from traditional medicine practices, etc – all this in just 2 weeks so far.

While patients are cool to see, my favorite part of the clinic visit is the counseling because I get to teach – why I’m in medicine!

The majority of the kids are adolescents/teens, so most of my time is counseling on medicine adherence (you absolutely cannot stop/skip taking HIV medicines or viral resistance develops). Each visit, the nurses count the pills to check compliance, but it’s tough because there’s still pill tossing or hiding the pill under the tongue and spitting it out. A lot of times we find out noncompliance too late … when the labs monitoring the CD4 and viral load reveal the truth 🙁

While English is the official language and school is taught in English, there’s still a language barrier with the younger and less educated patients. A lot of counseling is encouraging them to go back to school / stop failing school. For the teens, I always give the talk substance abuse, and more importantly, sexual protection. For a country with such a high HIV prevalence among youth, it’s still hush hush, which makes finding acceptance even tougher.

And of course there’s supportive care – psychology (for educational assessment, “disclosure” – when kids learn they have HIV and why they take HAART, depression), dietician for malnutrition (lots of patients), and social work (these are the saddest – kids will be doomed to treatment failure unless an adult takes responsibility, and it’s rough seeing kids panned off from relative to relative without good care).

After clinic, I walk home back to my flat (thank goodness it’s winter in the Southern hemisphere), which takes about 30 min. It’s so dusty and dry that I’m covered with orange dust when I get home. One day, I happened to run into three cows wandering along the roadside – they had cowbells, but no owner in sight, and they just moseyed along. As I watched my dinner walk away, I nearly got run over; here they drive on the right side of the road British style, which is just so bizarre to me, and out of habit I keep looking at the wrong direction when crossing the road.

While the variety of food is limited to mostly starch and meat, there’s no lack of protein. Beef / streak is BIG in African cuisine, and meat is plentiful. And they have SO many eggs – the cartons just sit out since they don’t refrigerate them (NPR has a great article). While Botswana has to import a lot of its produce, avocados are super cheap.

So you can guess what I’ve been eating….yes steak, eggs, and avocado. Good for breakfast, lunch, and dinner!

I was delighted that my flat has a small kitchen (with the most darling plates), so I’ll be sharing some African food in upcoming posts – this rub is from North Africa, with its many exotic Arab spices (I never had cinnamon on a steak before, but it’s delicious!) I’ve also never had this type of avocado, but it’s creamier than the Hass variety I have back home, making it a great spread for toast. I also never eat brown eggs, so it was fun playing with the color in the photos. Spice rub and steak adapted from Country Living.

I could ramble about my life here forever, but I’ll stop for now, so you can make this recipe!

North African Spice Rubbed Steak and Egg Avocado Toast

2-3 steak, cut into pieces *
olive oil
1/2 teaspoon coriander
1/4 teaspoon cumin
1/4 teaspoon tumeric
1/2 teaspoon ground cinnamon
1/2 teaspoon peri peri (African chili) spice (or paprika)
sea salt and pepper, to taste

1 small ripe avocado
1/2 teaspoon peri peri (African chili) spice (or paprika)
pepper, to taste
2 eggs
2 slices bread

*Here in Africa, the groceries don’t really label the cuts of meat, so I don’t know what cut I have … but you could use strip steak or T-bone.

STEAK: Rub steak with spice mixture, making sure to cover both sides, and marinate at room temperature for 20 minutes. Heat a large skillet over high heat until hot. Add the oil and pan sear the steaks until a brown crust forms.
EGG AVOCADO TOAST: Toast bread until golden brown. In a small bowl mash avocado with a fork and season with spices. Cook the eggs as desired (scrambled, poached, fried, over easy).** Spread the avocado on the toast and top with egg. Serve alongside the steak. Enjoy!

** Microwaved eggs cooking hack: Because I don’t have a nonstick pan to cook eggs in my kitchenette here, I simply rubbed a plate with olive oil, cracked an egg on top, and microwaved in 30 second increments until the egg was cooked (warning: the egg will splatter).

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *


  1. I loved reading about your experience in the Botswana HIV peds clinic. I've never done international medicine, but it seems so fascinating. The pathologies there are often so different from here. If would be so nice if I can contribute in some way in the future and either work at one of the clinics for a while or teach. We don't have a global heath elective rotation here, but maybe sometime as an attending! The spices with cinnamon on steak sounds very interesting and delicious. I like salty on sweet (sea salt and cookies) so this seems like an interesting sweet on salty combination. Have fun on the rest of your rotation! Glad to see you are making time for recipe posts while you are there!

  2. you're doing such a service! i can't pat you on the back from here, but i can tell you that i admire your efforts!
    avocados are the bomb diggedy and i'd be lost without them. this is a fine way to consume them, and i like your egg hack!

  3. Such a cool experience, and that recipe sounds delicious. Definitely something I'll have to make at home (and remember the egg trick, too fun!) honestandtruly.com

  4. I just randomly ran across your blog and really enjoy reading about your experiences and delicious recipes. I made this for my family tonight and my 2 yr old actually loved the spice rub on the steak and avocado spread. I can never get him to eat steak. Haha Pretty awesome. I did end up googling how to make my own peri peri spice and used that in place of paprika substitute. This turned out delicious.

  5. Hows it feel to stare your future dinner in the eyes?

    You can do a lot worse than eggs, steak, and avacados! I think we both can subsist on those 3 ingredients for quite awhile =)