Final Week in Durban :)

Pictured Above: Larissa, Christie, and I posing for a self-timed photo during our hike through "The Burg."  Clearly we weren't worried about the news of an unfortunate car hiccup that morning ;) 

Hi everyone,

Well I've finally made it to the final week of my eight week stay in South Africa, and this will likely be my final post from overseas!  It's felt shorter than it has been, and yet we've still been getting out and seeing and doing a lot! When I return home, it won't be with feelings of regret about missing out on anything.

The second and final of our weekend trips out of Durban was to the Drakensburg Mountains.  We went on a much lower budget than St. Lucia and majority of us stayed at a backpackers' lodge, only paying a slight upcharge to upgrade to heated rooms.  It did get cold outside at night and in the morning, but luckily the snow we were fearing never materialized. 

There were a number of things to do at a range of costs and everyone found something they liked.  Some did a mountain climb up to some rocks with art drawn by the bushmen of centuries ago, while others took a 4x4 over the mountain pass and into the small mountainous country of Lesotho (Luh-soo-too), whose border is completely enclosed by South Africa.

As for me and a couple other girls, we went for distance on foot and completed an eighteen kilometer hike over the course of about six hours across the landscape by our lodge.  We climbed mountains and traversed wide flatland and plateaus.  The scenery was beautiful in its own way, and much more barren and open than the hiking trails in the mountains around Cape Town.  It apparently has a very similar profile to the Mountain West states: Utah, Wyoming,.... though I've never been to any of those.

Our cars were working well for nearly the whole month until we finally ran into a snag over the weekend, and of course, way out in the countryside.  Our automatic shift car (which I don't drive!) suffered a flat tire on Saturday morning, and the spare was put on for the rest of the day, before we were fortunate enough to find a service station on Sunday morning that plugged the hole before our departure.  I guess we were as lucky as we could have been given the circumstances!

As mentioned in my previous post, my final week is being spent in the smaller primary care clinics.  Monday and Tuesday I spent at Blue Roof, which is privately sponsored by the Alicia Keys Foundation, among others.  It exclusively treats patients who are dealing with HIV/AIDS by bringing them in for check-ups, logging their use of the anti-retroviral (ARV) drugs that Blue Roof provides to prevent the virus from destroying their immune system, and consulting them on the lifestyle they need to maintain to stay healthy while carrying the condition.  The people there have been very nice to work with and I've worked/observed in a few of the areas, crunching numbers to determine how well patients are taking their pills, observing consultations, and assisting in the pharmacy.

HIV/AIDS is the primary healthcare concern that is plaguing South Africa, and the circumstances by which it arose are complex and unsettling.  South Africa boasts the highest rate of HIV-positive individuals of any country in the world, and the KwaZulu-Natal Province contains the highest number in the country.  Many things have changed for the better since the country transitioned to democracy in 1994, but I cannot say that healthcare is a sector that has entirely benefitted.  The leadership after Nelson Mandela took steps to prevent the ARV drugs from reaching citizens, even to the degree of outright denying the existance of HIV & AIDS.  While they are finally relenting and doing better to deliver the drugs to clinics, much of the funding for them still comes from countries overseas like the United States. 

I wish I could spend more than a couple days at the Blue Roof Clinic, because their efforts seem to get at the heart of what is really preventing South Africa from emerging as a strong and prosperous member among the first world nations. 

But otherwise, it's only four more days until I leave for home :) Can't wait to see everyone and hear your stories from the summer.

Cheers,

David

St. Lucia Weekend Overview

Pictured Above: Posing with the Zulu dancers at PheZulu Park after their performance on Tuesday.  They re-enacted traditional dances and skits associated with a Zulu wedding.

Hi all!

As you might have gathered from my facebook statuses from the weekend, St. Lucia was all about the animals.  In our three day stay, we did three safaris, a river cruise, and visited a cat rehabilitation center. 

Friday evening was our river cruise, where we went out and saw hippo herds on the banks of the river and in the water.  Yes, many of the townfolk do claim to see hippos walking the streets of St. Lucia at night, to get to their grazing grounds, but we weren't lucky enough (or maybe we were) to spot one.  Surprisingly, hippos are considered to be one of the most dangerous animals in Africa.  They walk the same routes everytime to get from the land to the water and if you're in the way of their charge back to the safety of the river, they don't simply go around.

We woke up early Saturday morning for an all day game drive.  It was exciting to see many of the animals  that we missed on our Garden Route safari, including giraffes, warthogs, zebras, and a cheetah.  We also tried to spot the ever-elusive leopard on a night safari that evening.  As much as we tried to spot the red reflective eyes, no luck :(

Monday was a public holiday, so we stayed in St. Lucia for the extra day and visited the cat rehabilitation center.  Our guide, the director of the center, spends all his time looking after wild cats that have been displaced, caring for them while they are in captivity, and releasing any offspring back into the wild before they are imprinted by a human presence.  These animals were super friendly and in many cases, willing to let us get close to and in some cases touch them.  We were actually able to take turns cuddling with a pair of cheetahs.

Our weekend was definitely fun, and I was pretty spent when we made it back Monday evening.  This week we are in a new location for clinic, St. Mary's Hospital, which is funded primarily by the government but also in part by the Catholic diocese.  It is smaller and serves a more rural community.  Tuberculosis infections are common, and all staff must wear respirators in a majority of the wards.  The first  couple days I have spent in radiography (X-ray and Ultrasound) and surgery, where I saw my first couple of Cesarian births. 

It is a short week, and we are thinking about our next weekend trip to the Drakensburg Mountains.  Our accomodations there will be much less luxurious which doesn't quite match up with the harsher climate.  Temperatures can dip below freezing at night and the air starts to thin out towards the tops of the peaks.  We'll have to be careful as we aren't equipped for serious climbing.  Things could get interesting!

As the weeks continue, I am still learning about the cultural background behind many of the cases that are unique to the country and uncommon/nonexistant in the States.  Early and frequent pregnancy, as well as unconventional abortion flood hospitals with complications and stress.  Smoking and other factors that lead to tuberculosis infections warrant x-ray after x-ray of the chest.  Nearly the entire men's surgical ward at King Edward housed victims of stabbings and other violence.  It seems that in each department we visit there is little diversity in terms of the cases that they see.  Each is filled with people having the same kinds of issues.

Well not to count down, but I return home in ten days :) I know a good few of you miss me! Looking forward to re-connecting again soon. 

Cheers,

David

Surgery then off to St. Lucia!

Hi all,

Just wanted to send off a quick post before leaving for the weekend!  We finish clinic early tomorrow (Friday) to get on the road to St. Lucia, a popular satellite destination here in the Kwazulu-Natal province, and about a 2.5-3 hour drive north up the coastline.  We will be going on a few safaris, in the morning, evening, and at night.  They will feature animals such as hippos, crocodiles, zebras, giraffes, and of course, the Big 5 (lion, rhino, elephant, cape bison, and leopard).  Kind of like the Durban equivalent of the Garden Route!

It was also a very interesting week in the medical field.  I have been in the surgical ward, much different than pediatrics.  The facilities are much older than before and seem to be on their final legs. A new hospital is actually in the works.  On our floor they divide the patient load between two surgical teams, and our team uses each day in a different capacity.  Modays and Tuesdays are in the operating theatre (OR), Wednesdays in "scopes" or the gastro clinic to do endoscopies (scope into the mouth, down the esophagus, stomach, and into the small intestine) and colonoscopies (scope into the anus and up through the colon).  Thursdays are in the clinic and Fridays a large round through the ward.

Monday was a bit of a let down because no procedures were scheduled, but we met our team and joined them in the round.  Also visiting in the team are two German medical student and an Austrian.
Tuesday was the highlight of the week, and Christie and I were in theatre the whole day, and saw four procedures.

They included:
1. Laproscopy to probe the abdominal cavity for tuberculosis (there was)
2. Excision of breast tissue (in a man) behind the nipple to check for cancer
3. & 4.  Removal of a hernial sac in the abdomen and repair.

After having great difficulty in the theatre a few weeks ago, I was surprised with how well I coped this time around.  Only on one occasion during the first procedure did I feel the need to sit down, and after was fine!

Viewing endoscopies and colonoscopies the following day was also quite surreal the first time.  It was very cool to actually view the inside of these organs in a living person.  It actually reminded me of the one "Magic School Bus" episode where the class shrinks themselves to see the inside of the body.

Medically, I think I've enjoyed this week more than the last.  The team has been fun and they are very willing to answer the many questions I've had.

Just a interesting fact: Surgeons in South Africa (and the U.K.) actually switch their title to "Mr." from  "Dr." once they have passed their final surgical exam and can practice independently.  Seems silly to get off the high of graduating med school, getting called Dr, and then a few years later, going back to Mr.  The reason has roots in historical surgery, where the physicians were not skilled enough with a knife and so the barbers who had much better control, but no medical degree, actually performed the surgery.  Since then, surgeons retain the title of "Mr."

Sorry for no new pictures today, but I hope to share some of the many I take in St. Lucia when we come back!

Best,
David

Getting Acquainted with Durban

The CFHI Durban group on the Observation Deck atop Moses Mabhida Stadium last Saturday evening.
Clockwise from bottom: myself, Alexis, Larissa, Jessica, Lindsay, Christie, Sarah, and Jennifer.

The inside of Moses Mabhida Stadium, the jumping platform is on the second highest horizontal from the arch. What a rush!!

Waving the flag to cheer on the Springboks! 

Hi everyone,

So already we've concluded our first week in Durban, the second site of my trip.  Since my last post, quite a lot has happened and I hope you don't mind me telling you about it :)

My clinical rotation last week was in pediatrics at the King Edward Hospital, a tertiary/academic/teaching hospital with over 1000 beds, under the instruction of Dr. Ramji, who has practiced there for over thirty years.  Tuesday and Wednesday we joined several interns in observing as he made his rounds about the 20-patient acute care ward (for new admits undergoing stabilization).  Because nearly all of the patients are under two, the main aspect that differentiates this kind of care from other forms of medicine is having to make conclusions from behavioral cues instead of verbal (Is he drinking water, why is she crying, are they smiling, etc.).  Thursday I moved over to the neo-natal ward, for premature newborns.  Some of these babies were born under two pounds.  Correct me if I'm wrong mom, but I think I came out at over nine, so there's some perspective.  It wasn't the easiest day for me, but it is incredible to think that many of these babies grow up to function just fine and live normal lives.

Thursday was also a big day because we finally solved our car dilemma and aquired two rentals, a manual shift (again, none of the girls know how to drive it)  and an automatic.  We took them downtown Friday afternoon to the stadiums downtown.  The soccer stadium, Moses Mabhida, has a gigantic arch spanning the length of the stadium over the field, and a cable car goes up and down along the top.  For about five dollars we were able to take the car up to the top of the arch and the observation deck, to look out and see an excellent view of the city.  The fact that the sun also happened to be setting made it quite beautiful.

Saturday was definitely the highlight of the weekend though.  Getting into town early, we arrived as the box office was opening to purchase tickets for an international rugby double-header in the evening, Scotland vs. Samoa and Italy vs. South Africa.  The South African rugby team (The Springboks) are one of the most storied teams in the country's post-apartheid history, and the subject of the film that came out a few years ago starring Morgan Freeman and Matt Damon, Invictus.

In the meantime, Jen and I felt like putting our lives on the line in attempting the World's tallest swing, under the arch of the stadium, and over 300 feet in the air.  It was 350 steps up to the jumping platform.  Leaping off felt like free fall until the rope tethered to the top of the arch brought us gliding above the soccer field.  It was an amazing thrill, and dangling there as I was pulled back up was almost as scary as the jump!

The rugby was just as exciting.  The Samoans treated us to their tribal pre-game war dance and went on to beat Scotland.  In the stands, we heard some guys playing their bagpipes the entire time, still showing very much pride, with the crowd clapping along.  At the start of the second match, the Springbok players were greeted with thunderous fireworks and applause.  Theirs wasn't even a contest as they smothered the Italians, scoring try after try with superior speed.

This coming week may be a little trying for me, because I will be shadowing in the Surgical Department at King Edward.  The girls there last week had a great time, I hope I can get over my apparently weak stomach and really see some cool things.  There is still lots to do, and the next two weekends may be used for overnight trips to St. Lucia and the Drakensburg Mountains.  Each is about a 2-3 hour drive.

Five weeks in, and three to go, I'm very much looking forward to coming home again :)

Cheers,
David

First Few Days In Durban

New city, new challenges.  Last weekend I flew from Cape Town to Durban on the eastern coast of South Africa.  The most interesting thing: my plane was orange.  The seats were pretty cramped, but thankfully it was only a two hour trip.

My new host family consists currently of a mother and her two daughters.  They speak both Zulu and English.  With a group of eight students, the other seven of which are also girls, there isn't much of another male presence to be found.  But I'm getting used to it.  The other students are of a diverse range of ages and stages in their education as well.

Our first couple days consisted of driving tours of the surrounding townships and city.  The main difference between the landscape here and in Cape Town is that it is much more hilly in the suburbs.  Neighborhoods are built on the hillsides instead of the densely-packed townships in CT.  That doesn't mean a lack of people, the township of Umlazi is home to over two million, the second largest in South Africa.

My time here is divided by week: The first two I will be working in the gigantic tertiary hospital downtown, known as King Edward, the first in pediatrics and the second in surgery.  My first day there today was informative; the primary medical concern for children under the age of two is gastroentilitis(sp?), a condition causing diarrhea and dehydration.  The pediatrics facility was recently updated and seems much nicer than anything I've seen here in the country before.

As far as anything else to do around here, it's tricky.  The internet is even more difficult to come by so I can't say as to when I'll be able to post again. We're also still working on renting a car; it's hard to go anywhere inexpensively without one.

Into my fifth week away from home, I'm starting to miss it more and more.  I'm trying to repress the feelings of wanting to go back because I still have three weeks left here to learn and enjoy.  I know when I leave, that it will be uncertain as to if and when I can come back so it's important to keep that in mind.

Sorry for the lack of a photo today, I promise I am still taking them, but I'm working from a desktop in the library without an SD slot.  Hope everyone's enjoying their summer, it certainly feels like summer again here :))

Best,
David