Closing the Curtain on Cape Town

Pictured Above: In the stands of Newlands stadium (capacity 75,000) supporting Stormers rugby!  The SupeRugby league is kinda cool: it consists of three conferences (South Africa, Australia, and New Zealand), with five teams each.  They play matches domestically and abroad.

Hello everyone! Sad to say, this is my final week in Cape Town. The past week has been just as eventful as the rest, and we are starting to wrap things up.  I'll try to summarize it as best I can!  The rest of the week and today I spent in the Trauma/ER unit of the Delft clinic.  I was back with Dr. Lukhaski today, but also was able to shadow a couple other of the physicians.  With very little clinical background previously, I am learning a lot!  A large fraction of the cases are for chest pain, products of extensive smoking, asthma, and past history of tuberculosis. Yet I have been able to see cases that are more unique and interesting! Amputation, chest draining, and intubation are a few of the treatments I have witnessed.

Shifting gears a little, the past weekend was again packed.  After climbing Devil's Peak Friday, I had the chance to cheer on the Stormers, Cape Town's professional rugby squad, play against an Australian opponent on Saturday.  Stormers were definitely underdogs, but they held off the visiting Reds in a tight match and emerged victorious 20-15! It was very exciting, and followed by a very entertaining viewing of the European Champions League soccer final (Munich defeating Dortmund 2:1 in an exciting all-German final at London).  Sunday was much more leisurely as we explored the neighboring town of Stellenbosch: Afrikaaner wine country.

As we get closer to departure, our touring is near complete and we've hit all the important spectacles, except for Robben Island.  The former Apartheid prison for Nelson Mandela and his fellow political prisoners was one of my top destinations in Cape Town, yet with recent mismanagement the attraction is apparently not what it used to be.  Nevertheless, I still find myself immersed in the relics of Apartheid every single day.  It's not something I have to visit, I'm very much living in it.

As I look forward towards my flight to Durban on Saturday, I've been thinking a lot about my time here and if it met my expectations.  It has, and also exceeded them.  I've gained a perspective of the country through my medical work and service that I don't think any casual tourist could ever attain, yet still found the time to enjoy the city as much as anyone else.  Four weeks has been the perfect length of stay.  Not surprisingly, I will have to keep a closer eye on my cash flow next month...

I also think about what Durban will be like.  Likely more consistently warm for a start.  It also has the largest population of Indians outside of India.  Mahatma Gandhi even lived there for a period of time.  I have my new host family assigned, and Christie, one of my fellow students here in Cape Town will be traveling to Durban as well.  We will be staying in the same household.

It's as much to think about as it is to write about!  I'm glad we could catch Cape Town's last summer days, but we are seeing increasingly more rain.  I hope to hit the beach in Durban often!

Hope everything's well in the mitten, keep cheering on the Red Wings to close out the Hawks!!

Best,
David

More Exciting Sights and into the Third Week

Pictured Above: Mr. Basil's 6th grade class at the primary school in Genadendal after our discussion on substance abuse.  Can you pick me out?

From Tuesday 5.21.13

Back in the city!  We wasted no time after our return to Cape Town last Friday.  The weekend was packed with activity. After going out that night, we got up to drive down to the Cape Point, also named by the early Portuguese explorers such as Bartholomew Diaz and Vasco de Gama as the "Cape of Good Hope."  Cape Point is the tip of the Cape Peninsula and often mistakenly believed to be the southern tip of the African continent.  The actual southernmost point is much farther East, but the view isn't as good!

The Cape of Good Hope was named as such because it is the geographic point where the cold Atlantic Ocean current and warm Indian Ocean current intersect.  This collision creates conditions of extreme wind and rough water, which have driven countless ships to a watery grave as they try to round the Cape.
The drive along the Indian Ocean side was more than pleasant as we followed the road along the sea.  It is lined with beach towns, each with all sorts of shops and places to buy and eat fresh seafood.  Besides taking in the view from the tip of the peninsula, we stopped at a penguin beach (that's right, penguins!) on our way back.  We were able to get very close to a few nesting birds.

The next day we made it over to the Clifton beaches.  It seems as if the Devil's Peak/Table Mountain/Lion's Head chain are a fence.  To the East lie the townships of the Cape Flats region where we are staying, dominated by poverty of the townships and settlements, yet rich with culture of the black and coloured peoples.  But to the West is the very serene hillside coming down from Lion's Head and Table Mountain down to the beaches, where the views are unmatched and the real estate as expensive as ever.  It is also very much populated by whites.  Driving from one side to the other it's like living in two completely different cities altogether.

But anyways, I did come here for service learning, and that should probably be addressed at some point too. Today and yesterday we started our rotations in the Delft Community Health Center.  This is a facility that was built for the Delft community several years ago of around 90,000.  Today it services over half a million.  Nothing I have ever encountered matched the amount of crowding and stress on this small and understaffed medical center.  Patients schedule their appointments ahead yet must still arrive as early as six in the morning to wait in the ques to receive their file and go through the prep room before moving on to the doctor.
Monday I assisted the two nurses in the prep room, taking the blood pressure (They luckily had two automatic devices) and weight of every patient in line, while also having to learn their filing system on the fly to make sure their files got where they needed.  It was stressful work as we serviced a never-ending line for several hours.  I must have gone through a hundred people.

Tuesday I started in the same role, but not long into my work one of the general care doctors pulled me aside.  I told him me and my fellow students were volunteers from America. "Why would they put you here in this sh*thole?" he asked me.  "Come, let them do their jobs here, I will bring you to where the action is."  He brought me over to the ER/Trama center where I shadowed the senior physician, henceforth known as Dr. L, because I cannot spell or pronounce his name. He came to South Africa to practice after studying in the Congo, and spoke French as his first language, though he was able to explain things and answer my questions in English fine.  With Dr. L I observed as he saw all sorts of cases that occur in a primary care ER: broken joints, asthma exacerbations, genital infections, and a man with his left lung almost completely filled in with fluid and scar tissue after having three bouts of tuberculosis.  I feel I satisfied both ends of my expectations in my work at the Delft clinic.  Working strenuously in the prep room gave me great appreciation for the amount of care they are trying to provide with so few resources, whereas working in the ER with Dr. L provided insight as to what ailments are dealt with on a daily basis, and how primary care facilities must often refer their patients to a secondary or tertiary hospital facility to provide the patients the care they really need.

Tomorrow and for the rest of the week we will be moving onto new facilities in the Cape Flats area to see what sort of health care they provide.  It's a little hard to believe that we only have a week and a half left here in Cape Town, but sometimes I find myself starting to think about moving onto Durban.  I'm still very glad I have that opportunity.

We heard about the tornado in Oklahoma today, and our thoughts go out to all affected by it.

Hope everyone's having a good week otherwise, I'll be sure to write again soon.

Totsiens,
David

The Week in Rural South Africa

Pictured Above: Taking a patient's blood pressure during a home care visit last Tuesday

Well everyone, seeing as it’s been over a week since my last post, and so much has happened since, I thought it might warrant two: the first about our weekend on the Garden Route, and this one about our week in the rural town of Genadendal.  We arrived here on Sunday evening and stayed here until Friday, when we returned to our home stays just outside of Cape Town. 

Here in Genadendal we did quite a variety of things, each day was different.  There are other students staying here in the town as well, a few from the University of Western Cape who practice physical therapy, but also sixteen students from Holland all studying various fields and applying them here in the town as a study abroad project. 

Our lodgings have been quite pleasant; we are staying in the guest house in the historic church square.  It is furnished almost completely with antique furniture and a woman named Maureen from the town is in and out all the time, cooking three meals a day for us.  We’ve used the fireplace every night to beat the cold nights. Overall, fantastic accommodations!

After all the orientations in Cape Town and sight-seeing, it’s been great to finally get into the service component of our trip.  Monday morning was spent at the clinic which is sadly understaffed.  Two general nurse practioners service everybody on most days.  The doctor comes by only to volunteer two hours at the clinic every week when patients are referred to him by the nurses.  The dentist, the most popular (many of the public are missing teeth and some older individuals have none), only comes by once a month. 

Tuesday, we teamed up with about 15 young women with the health department who go into the surrounding residential areas and literally go door-to-door to check up on the inhabitants who are dealing with any sort of condition (very frequently high blood pressure or diabetes).  That morning, I accompanied two the women and visited about twelve homes.  At each one, we usually took blood pressure and/or tested their glucose level.  After coming in with virtually no nursing experience, at least I got good at those!

Wednesday was similar, except in the nearby town of Greyton with the local chapter of the South African Red Cross.  They also offer kids care in the afternoons so the three girls and I have gone over a couple times this week to see the kids and play with them.

The final days are more geared towards introducing health-themed topics in the education system.  This morning we assisted the UWC students in introducing the topics of bullying, drugs, and nutrition to young students in the 4^th, 5^th, and 6^th grade.  Tomorrow, we will be splitting up to each talk to a different group. The girls will discuss hand-washing and other hygiene with preschool children while I plan to speak to older kids, 6^th and 7^th graders, about substance abuse.  We’ll see how they take to it!

Besides being the minority gender in the group, I have also been working through the challenge concerning the decisions for my future.  Many of you may know that I study biomedical engineering at the University of Michigan, a very rigorous field of study technically, but also with a significant number of students who plan to go into medicine.  For a while, I’ve been on the fence about what I may choose to pursue after: either medicine; or research, something a little more technical and science-ey. 

The three girls I’m here with are all pretty stuck on the pre-med track, and in that way also, I feel like the odd man out, still trying to figure out if clinical work is something I enjoy and would like to take further.  At least here in South Africa, I feel like I’m starting to understand the essence of being a clinician and what the mentality behind care-giving is. 

Well, I suppose enough rambling. I’m looking forward to returning to Cape Town to see what our clinical duties will be there, as well as continue on our impossible task of seeing everything there is to take in.  We still have intentions to catch the view from Signal Hill, tour some wineries, and see Cape Point, the bottom of the peninsula to the south of the city and the accepted point where the Atlantic and Indian Oceans meet. 

Hope everybody is enjoying their summer! Even here in the southern hemisphere it still feels like it most times, though some of the trees are starting to change color.

Totsiens,

David

Our Garden Route Weekend

Pictured Above: Standing next to one of the many elephants on the Knysna Elephant Reserve on Saturday.  We were able to touch them as well as feed them by hand. As gentle as they are, their size and the strength of their trunks still made them a little intimidating!

I sincerely hope the posts have come often enough.  The difficulty of getting reliable internet access has definitely taking some getting used to!   Today I am writing from the small town of Genadendal (pronounced "huh-NAH-tin-dal") where we recently arrived last Sunday night.  We will be staying here for the next five days working in the clinics and traveling with the clinicians to some of the homes to visit patients who are treated at home.  This town has a proud history centered around its establishment as the first mission and church in South Africa.  English is also apparently a little hard to come by so it might be a good chance to really learn some Afrikaans.  We're all really excited!

We were able to get out and have some real fun this past weekend as we toured the Garden Route, the coastal region between Cape Town and Port Elizabeth to the East.  The main road is studded with towns, restaurants, and countless attractions and activities to see and do.  Our Friday itinerary included touring an ostrich farm and the caves of Cango.  The farm allowed us to ride on the back of the flightless birds for about a lap around the enclosure which was definitely a highlight! The caves were interesting too: dark, spacious in some places, tight in others, and humid everywhere (reaching up to 97%). 

Saturday was even busier.  We took a zip-line tour, visited an elephant reserve and enjoyed a short cruise at dusk in the estuary near the town of Knyzna (niz-nuh).  Our final day, Sunday, was filled by our day safari on the Botlierskop Game Reserve.  Though a little unpleasent from the horde of obnoxious Argentinian tourists on our vehicle, we were still able to see quite a variety of African wildlife including wildebeast, impala, cape bison, lions, elephants, and rhinoceruses.  The safari was capped by a wonderful meal in the main lodge.

For the fee that we paid to do the Garden Route, our money went a long way.  Since the coordinatiors for CFHI Cape Town, Marion and Avril, have been doing the Garden Route with their students every month many years, they are well known by the businesses with which we organize our activities.  They have done an unbelievable job pulling strings, getting us great deals and really maximizing our mini weekend vacation! 

My first week here seemed to go by quickly, but staying here in South Africa for seven more weeks still seems like a long time.  With each passing day, I feel myself becoming more accustomed to the culture here, and it's really cool!  Because of its many influences it is truly complex and unique.

As always, thanks for reading and check back in a few more days!

Totsiens,

David

May 7th Cape Town Update

Pictured Above: Me and my three other fellow students here in Cape Town this month for CFHI, posing during our decent from the top of Lion's Head (other photos from the hike will be posted later!). The city bowl descending from signal hill and the bay is visible to the right.

Clockwise from top: Kelsey, Christie, myself, and Lindsey.

Hello everyone, Howzit?

Sorry for the delay between posts, I had written this in the McDonalds last night but lost my 1hr connection before I could post. Still, the first couple days here in Cape Town have been great!

The journey was quite a ride, which included no less than an hour flight to DC (with a 6 hour layover), a 17 hour flight to Johannesburg (with a stop in Dakar, Senegal) and a final 2 hour leg to Cape Town, overall, about 29 hours of travel.  I met a few interesting people during the flights including a young woman who was half-Senegalese, half Italian, and spoke French and worked in a French school in the Ivory Coast teaching biology.  Plus she could talk to me, so that's a total of four languages. Pretty impressive! Needless to say, I'm glad I made it.

The weather has been wonderful, Mediterranean-esque, with strictly sunny days so far.  Yet of course here in the Southern Hemisphere we approach the winter months, which really means rain and temperatures dipping to around 15-20C (50s and 60s F).

I am living in a middle-class suburb with a host family of retired teachers and their youngest son who is 24 years old.  They have been friendly and show a good knack for cooking, though I haven't tried anything too exotic yet.

I have also met a few of the program coordinators, who have been able to discuss with us the history, demographics, and health care system of South Africa and the Cape Town region.  Instead of jumping right into our clinical rotations we spent the day riding in the car of a social worker friendly with CFHI who was an expert on the history, neighborhoods and people of Cape Town.  It was fascinating listening to her endless accounts and stories.  Already having a significant portion of my 10th grade history class devoted to studying exclusively South Africa, I was already familiar with much of the history (snaps to you, Dr. Greenspan), but it was certainly interesting to hear it again.  Most of the neighborhoods we toured were exclusive to one of the main ethnic groups: black african, cape coloured (a mixed race of asian, indian, black, and white), and white.  Nineteen years after the end of apartheid, the racial divisions in Cape Town remain strong, a division that wasn't as evident when the world's eyes were turned to South Africa for the previous World Cup.

By the end we were exhausted. After a good night's sleep, we set off today for the University of Western Cape to be registered as students, enabling us to do the tours and rotations we will be experiencing.  We then succeeded in transporting ourselves to the other end of town to climb the Lion's Head peak. A bit of a challenge, about the same-more rugged than the ladders in Acadia.

Other highlights to look forward to include the Garden Route from Friday through Sunday, which transitions straight into our rural encounter the following week. Sadly, no posts may come during (expect no McDonalds restaurants), but there will be plenty of stories after!

Hope all are well, miss you and thinking about you!

Totsiens,
David

Pictured Above: Cape Town, surrounded by the rock formations from left: Lion's Head, Table Mountain, and Devil's Peak.  Foreground--Green Point and Green Point Stadium, built for when South Africa hosted the 2010 World Cup.

Hello everyone! Crazy as it is for me to think about, I will be departing Friday for South Africa to spend two months, May 4th through June 29th, volunteering for the global health education program Child Family Health International.  The month of May I will spend working in Cape Town and the month of June in Durban, a city some 2000 miles east, right on the Indian Ocean.  In each of these locations I will be working in clinical rotations at the city hospitals, working in numerous specialties including general care, HIV/AIDS treatment, and surgery.

Additionally, in each of these locations I will be spending a week outside of the city in a more rural location to learn how healthcare is approached in those communities.  I was recently informed that this portion during my stay in Cape Town would take place during my first week.

For each month, I will be staying with a host family.  During my time in Cape Town I will be staying in a suburban community of Athlone in the Cape Flats region that is southeast of downtown.

Traveling from the United States with me are three other students, one from the University of Michigan.  We will be staying close to each other, and possibly work in some rotations together as well.

I will be leaving from Detroit around 10:00 am Friday, and arriving in Cape Town around 9:00 pm Saturday, local time (6 hours ahead).

Well, I should get back to packing, but I can't wait to share my first adventures with you!  If you have any other questions or short messages for me, you can leave a comment! This will be something that is challenging, but life-changing, and I hope to learn as much as I can to expand my outlook on the state of healthcare around the world, and where it could be headed. Until next time!

Totsiens,
David