imetzler

10 November 2006 @ 07:20 am

Well the last weeks have been spent back revisiting places and people we wanted to see before we wrapped things up. We also found a site called Health System Trust that was a great resource for the research I have to do before I get back.
An interesting side note – so when I got my phone ripped off I lost many contact numbers including the only way I had of getting in touch with that random run-in Devon. Bummer, maybe it was a cosmic hiccup…oh well. One of the days we toured around Durban in our last week, we stopped to check out the KwaZulu-Natal University and found our way to a little campus clothing store. Well to add another layer of believe-it-or-not to the story, five minutes later Devon walks into the shop to check out t-shirts and instead gets a second slack-jawed hello from me. Small world?! No way…

So now it’s the end of week ten and I’m headed west following the course of the coastline until the Indian merges with the Atlantic. I’ll be bouncing from backpacker to backpacker, boning up on my new surfing skills and meeting many other travelers with tales to tell. I’ll sip a cup of java in secluded Coffee Bay, catch Endless Summer worthy waves at Jeffery’s Bay and maybe sack up enough to dive off the world’s highest bungee-jump in Storm’s River. As my journey turns inland I may ride an ostrich in Oudtshoorn, definitely drink my way between fine wineries in Stellenbosch before I crash out at the Stumble Inn, and finally climb up Table Mountain to look down over Cape Town. Then if you can believe it, I’ll have the chance to do it all again as I journey back to Durban before saying my final farewells to the friends and family I’ve found in this fantastic country...

Hopefully I’ll be able to keep this journal updated, but it’s hard to know what’s in store. Despite the many adventures ahead, I deeply miss home and love hearing from you all. Please keep checking in, I’ll at least be keeping up with my emails. See you soon, I’m looking forward to sharing many more stories when I get back!!!

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02 November 2006 @ 07:18 am

Week 8

This week had four of us assigned to the largest hospital in the southern hemisphere, King Edward – part primary clinic, part referral hospital and part medical school. We had heard a lot about this place as it was the upgrade center for anything the other public facilities couldn’t handle. Littered with exhaust towers, boilers, compressors and pipes blasting steam into grates this place looked more like a power plant or factory than a hospital. My first day was passed in the dermatology department which I only found after navigating the endless mazes of labeled corridors and the dead ends of other departments. Health workers and other staff scurried through the halls like ants – making repairs, delivering supplies and carting around patients like helpless larva.

When I finally arrived, I was glad to see that Dr. Dlova was attending today. I had actually met her on my flight into Johannesburg what now seems like such a long time ago. After spending seventeen hours together flying over the Atlantic we had gotten to know each other fairly well and I was glad to have found her again. Because this was a teaching hospital I learned a bit about medical school in South Africa and saw a lot of teamwork and discussion happening between Dr. Dlova and the group of residents. One of the most jarring cases that day began as we were all called into an adjacent room to view a patient arriving into care for the first time. She was well overdue. In an obviously severe amount of discomfort, she sat hunched over on a bed with an entire room of people gawking at her. A red and inflamed rash covered half her scalp and appeared several other places on her body in addition to scattered large pustules, lesions and ulcers. Several of the pus-filled sores were so well-developed that you could clearly see the fluid level as she sat upright. An interesting day, but I seriously doubt if dermatology will ever be my chosen specialty…

I spent the remainder in the ICU operating theatre which I snuck into with the help of my wonderful host mom who worked there as the attending nurse. Thanks to her pulling a few strings I met many of the surgeons and saw operations ranging from pediatric orthopedics to maxillo-facial. One of the orthopods actually taught me how to scrub in and let me assist on one procedure, shoulder to shoulder. Only in Africa…I love government hospitals!

Coming back from clinic one afternoon, Woody, Sarah and I stopped by the neighborhood store to hire a few movies. We began our routine walk back to our houses, I was wearing dark sunglasses, joking with Woody and generally not paying attention since we had made this trek countless times. We turn a familiar corner past two young guys no more than fifty meters from my house. I suddenly noticed one quickly catching up beside us and just as quickly pulling out a blade and shoving it toward my stomach. When I backed off, he turned on Woody as his friend came up behind me scrambling to get into the pockets of my shorts.

I’ve been warned a hundred times and I’ve gone over this scenario in my head before. Nothing can ever prepare you. I was able to grab for my free program cell phone and toss it at the man’s grasping hands. As he fumbled to catch it I backed off enough to put a safe distance between us, sparing my wallet tucked in my back pocket. Luckily, he didn’t come at me again and I was able to turn toward Woody who was getting his wallet, phone and the movies ripped off and Sarah who just flung her jacket at the mugger. They ran back down the road and around the corner. This all happened in no more than a few seconds and is another one of those experiences that’s impossible to understand until you’ve been through it.

Obviously shook up and pissed off at what had just happened so close to our homes and in broad daylight, we retreated back to my house. When we told our families what had happened they reacted in about the same way as if you had told them that it was raining outside and we were quickly reminded how much worse it could have been. No one had been hurt and they didn’t get anything of value because the phones were crap and Woody cancelled his card immediately. We were very, very lucky. You can’t really defend yourself, they get the jump on you with a knife at you belly before you have a chance to do anything. If I had been paying closer attention I might have stared down the guys as we passed to show we knew that they were there, but the assholes looked like any other guys, clean cut and in nice clothes, and there’s just no way you can mean-mug everyone you see on the street.

We eventually had to report it to the police and our families took us down to the station, but we quickly saw that the cops are probably just as big of crooks as the muggers. They did absolutely nothing except tell us to call our service providers to blacklist the phones. I knew not to expect anything, but it still makes me worried about my host family that this is the support that’s “protecting” them from crime in their neighborhood. After we told this story to locals, the common response was “Welcome to South Africa.” It was also interesting to hear all the people that had never been touched tell us what they would’ve done, or ask, “Why didn’t you smack ‘em?!” when every single person who had been mugged before say that we did the right thing. Life goes on, we are still very lucky.

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27 October 2006 @ 02:33 pm

Week 6

St. Mary’s Hospital is perched in the hills on the outskirts of Durban. It’s an old place scattered with buildings connected by narrow corridors, staircases and dead ends. Religion saturates the place, nuns walk through the halls and crosses adorn the entry way and most rooms, including the OT. We go through the usual routine of being dropped off with an administrator, passed to a doctor who then tries to determine the area best suited to ditch us. When I asked this doctor what he did here he replied, “ I work where most men play, but don’t go repeating that.” I spent the day in theatre and ended up watching four Caesarian sections. After I scrubbed up, I couldn’t believe the next twenty minutes. The young Zulu surgeon cut the mother open like a ripe melon and pulled out a newborn – wrinkled and blue with a misshapen head the baby looked like it belonged on a late-night sci fi movie. Miracle my ass. Just as I thought it was over, he reached in again and plucked out another wriggling mass of wrinkles. Twins!

I spent the rest of the week in the HIV/AIDS clinic at St. Mary’s. I spent my time with a sweet Zulu lady, Dr. Zondi. She led me through many of the details of her patients, but regardless of her efforts most of the discussion flew by me in a whirl of clicks and pops. Even in a place where everyone can speak English if they have to, I run into the language barrier often.

Four of us attended the International HIV/AIDS Workshop dressed up and hoping not to stick out like the awkward foreign students we are. Hosted at the Hilton Hotel, this conference was filled with all the local doctors dealing with the HIV/AIDS epidemic, many of whom we recognized from our rotations. The majority of the night was directed towards case studies that involved ARV regimens, side effects, developed resistance patterns and advice on treatment alterations. It was truly incredible to be in a room with people who dedicated their lives to fight this disease at the epicenter of the epidemic.

While much of what was discussed was way over our heads, I picked up a surprising amount just listening to the lectures thanks to the previous weeks of exposure in clinics and my background in the biology of HIV. The speakers from Harvard as well as the contributing members of the audience were clearly committed to curbing the pandemic patient by patient. The sad and nerdy truth is that I had as much fun at this conference than at the night clubs the previous weeks. I can only imagine what it would feel like to have a complete understanding and weighted opinion propelling my interest. It’s experiences like these that fuel my passion for medicine and a growing interest in public health and teaching.

-

So I’m sitting in a restaurant with three of the other students and we’re placed right across the room from a couple about our age. I’m sitting so that I’m looking directly into the face of the girl and I’m struck with that weird recognition feeling. About halfway through the meal it hits me – Devon, 8th grade, Stanford Sierra Camp. No, no, no, that’s totally impossible. Sometimes I forget that I’m on the complete opposite side of the planet from home. But the more I star at this girl, probably creeping her out like nothing else, the more it reminds me of the girl I knew for no more than a week. Knowing it would bother me for the rest of the trip if I didn’t say something, I walked up to the table after we finished dinner.
“I’m really sorry to bother you both, but is your name Devon?”
A shy nod
“Did you go to Stanford Sierra Camp when you were like 14...”
“Oh my…God!”

Totally impossible…but there it is. She goes to school in California and is studying at the local University, in South Africa, in Durban, in this restaurant, now.

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20 October 2006 @ 09:16 am

Week 7

One of the women in the wards this week had cervical cancer which had recently spread to her spine and abdomen. Even before she spoke, her face made it obvious that she was in a tremendous amount of pain. Yet when we entered she greeted us all with a deep smile which remained even as we talked openly about her eventual death. It was clear that with the guidance of the hospice staff she had come far in acknowledging the end of her life and made preparations for her family, including her nine-year-old daughter. I stayed to talk with her several times throughout the week and saw that her struggle remained unfinished. Her story was a sad and powerful one and her strength showed through the telling of how she dealt with the cancer. She was battling with the pain minute by minute and even had to run to the toilet to vomit during one of our morning chats. I cannot explain what it feels like to stare silently at the hospital bed of a terminally ill mother while listening to her retching in pain on the other side of a paper-thin door. She has since returned to her family home to wait for her next round of chemotherapy and she will never leave my thoughts.

Over the week I got to know many of the patients through ward rotations and home visits with the nurses. I saw a variety of cases at many stages – a friendly, talkative young guy with progressive AIDS and uncontrolled histoplasmosis making his entire face blister, a middle-aged women with breast cancer that had taken its bilateral toll, an infuriated elderly man with jaw cancer on a year-long waiting list for much needed treatment, and a host of other heart-wrenching characters. Despite all this sadness, suffering and frustration, we always swapped positive stories and I never got out of a house without experiencing the incredible hospitality of this primarily Indian community.

On the death and the afterlife: “Can a caterpillar really understand it is going to become a butterfly?” ~ Dr. Nair

-

Mountains!!! Finally driving out of the choking city again, this time we were headed up into the rugged Drakensbergs. The group also had some new recruits, two post-bacc premeds, Woody from Lewis and Clark and Heather from PSU. It was entertaining to watch their faces as South African life fully came into view for them as the week passed. Both were excellent additions to the group and a lot of fun in clinic and out on weekends. Woody was as stoked as I was to finally be outside, he’s a genuine guy, with a touch of hippy, and a big bird buff, he gave a much needed personality twist to the group. Also, I was really lucky to have another guy in the group, for sanity’s sake. Heather did the same in her own way, married yet a model of a no limits attitude and hardly a stranger to gin and tonic she also added flare to our little family.

Bend after bend as the pot-holed road plowed ahead, we finally caught site of the striking peaks of the central Berg. As we approached our temporary home, the Inkosani Lodge, I was impressed by the beautiful grounds and peaceful atmosphere of the place. We awoke to the sunrise the next morning and drove up to the trailhead that would lead us straight into the movie backdrop-like surroundings. Marching up the pristine valley, full of foreign flora and fauna and patched with outcroppings of rock I was once again hit with the, “I’m in…Africa?!” feeling which was exponentially enhanced after spotting a pack of baboons resting on the trail ahead. The morning was spent climbing the cliff sides to waterfalls, grass strewn plateaus and astounding vistas. Just after lunch as we started our descent, dark clouds emerged from the far side of Cathkin Peak. Giant rain drops began to soak us as the first strikes of lightning reached our valley. The shuddering thunder added drama to our hike like the soundtrack of a blockbuster. The storm quickened our pace and drenched our clothes but never dampened our spirits.

When we returned to our lodge, wet and muddy, the first thing on my mind was a shower. Exposed to the lightning and thunder storm that had trailed us down the mountainside, I took a steaming shower in an alcove half under the cover of a thatched hut and sparsely leafed branches – an indescribable experience bordering on religious really. Afterward we all shared a home-cooked meal prepared by the lodge owner, perfectly hitting the spot and preparing us for a long night of drinks, games and laughs with the other travelers.

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09 October 2006 @ 02:29 pm

Week 5

The next week was half of the student’s last and we split up between two locations. The departing group went to King Edward while the rest of us were dropped off at Sinikithemba, Zulu for “we give hope.” Sinikithemba is an ARV dedicated clinic across from the large Mccord’s Hospital and is set up in a renovated church. At present the majority of their funding comes from PEPFAR allowing them to operate separately from the public sector. Organized and welcoming, Sinikithema is unlike any other site we’ve visited. After spending a week talking with doctors and staff, watching how patients are treated and volunteering to help update their electronic patient database, it became clear that this sort of program serves as a brilliant example of how to run a successful ARV rollout and HIV/AIDS management facility.

After getting a bit tired of data entry, I took the initiative to introduce myself to several researchers and HIV specialists at the top of their field here. They were all very receptive and helpful, but obviously extremely busy. I did get a lot of information from them, including several other contacts and even an invitation to the third “International HIV/AIDS Workshop: The Realities of ARV Rollout” which featured several speakers on ARV treatment for South Africa and Harvard Medical School next week.

I’m an idiot.

The last few days have been hectic ones because the students leaving Durban have been determined to make their last week memorable, and to them this means spending as much time out at night as possible. On night out at a bar, Casablanca, I managed to leave without my Visa card – the ONLY access I have to cash in this entire country. I’ve always been amazed at my continuing ability to forget things, but it doesn’t get any worse than this. Further compounding the problem, I managed to lock myself out of my online account and Casablanca is closed until next Saturday. I made the risky decision not to immediately cancel the card because it would mean I would be penniless until I somehow got a new card to Africa.

Long story short, it was a paranoid and tight budgeted few days. When I finally made it to the club, I tried to dash inside but the bouncer threw me out saying I wasn’t over 21, I snapped at him to take another look and we both realized that with the ordering of the dates being different here it made me out to be a few months shy. I explained my way in and rushed to find the bartender when I realized that all seven of the girls identically Barbie-like. After quizzing all of them about my card, I received only denials they had ever served me or had seen a missing card. Freaked out, I tracked down the manager, a dark and respectable man. He looked in his office for another painful fifteen minutes but producing nothing as he returned. After I bluffed witnesses to me leaving the card and calling a lawyer, he told me to cancel it and bring in a statement and we could discuss the charges. It was a reasonable response, he could have easily told me to get lost, but I was obviously unsatisfied. On my way out, with a wrenching in my stomach, I pulled over the girl who I recognized the most and persuaded her to look around again anywhere there might be a card. Sure enough, after talking with another bimbo clone she picked up a card off the register with a lighthouse and the word Oregon on it. My card.

I’m a lucky idiot.

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03 October 2006 @ 01:56 pm

Week 4

I spent this week volunteering at Zimisele, a small NGO stuffed in the back of a run down strip mall nearby the KwaMashu Clinic. Staffed solely by volunteer nurses, this program aids the sick and destitute by making home visits to ailing patients and providing daycare for unfortunate children. When we arrived I was assigned to two young nurses and I followed nervously as we walked into one of Durban’s poorest townships. It was strange to be strolling through the most poverty stricken and dangerous sections of South Africa so casually, but to these nurses, this was just…home. As we passed houses, shacks and small stores called tuck shops the people there would start laughing, pointing and yelling in Zulu as they caught sight of us. There was really no chance of avoiding it, in this place I had about as much chance of fitting in as an ostrich in Antarctica. Another one of the students had a boy run up to her in the street, drop to his knees and start bowing then run off back to his laughing friends. I’m sure the nurses were embarrassed to be walking with a “mlungu” but they didn’t let it show, I honestly believe if it wasn’t for these women and the respect they held here there wouldn’t be a chance of me making it out of here.

We arrived at the first house, if you could call it that, which sheltered the first patient, a seventy-six year-old stroke victim. When we walked in I felt the smell seep into me and I had to seriously resist gagging. The poor man was curled into the fetal position against the wall, under shreds of blankets and clothes on a makeshift bed no more than a meter from a perfectly clean bed where the rest of the family must have slept. We exchanged the shallow Zulu greetings that I know and the nurses went to work stripping off his dirty coverings.
The man told us his wife had left him there and he only saw his daughter once a day. We had to lift the man onto the clean bed to bathe him and do a bit of physical therapy for a disabled and infected arm and leg, he felt like nothing but loose bones as I picked him up. The nurses began bathing him after we boiled some bath water. I had to gently restrain the man from pushing away the nurse as she cleaned his painful gangrenous hand. After rummaging through the cabinets in the house, I found an unused tub of antibacterial salve which came in handy when we uncovered his many bedsores. From what I saw in the man’s eyes and from pestering the nurses to translate, the man was in surprisingly good spirits. He made the nurses laugh and joked at the new outfit we picked out for him – a green shirt and bright red shorts – he said that this with his curly white beard made him look like Santa.

By the end, he looked much improved tucked in a clean bed and covered in the medicated lotion. As we said our goodbye, he kept repeating something in Zulu. Outside, I asked the women what he had said and the nurse relied, “He said he is hungry.” I remembered the small bag of crackers I carried in my coat for lunch and ran it back to the man’s room and managed to perch it opened on his pillow. Though I couldn’t understand his words, his dark, hollowed eyes showed a deep gratefulness for such a pathetically small gesture, it only made me more frustrated that there was so little I could do for him. Later in the day we were able to bring him a few loaves of donated bread, but it still felt like I was using a thimble to bail out the Titanic.

Another patient we visited with several nurses was living in a lean-to that made the previous man’s house look like a mansion. This elderly women was very frail and partially blind. The nurses knew very little about her condition but I gathered that she had been an alcoholic and had a stroke. They sat me down in front of her and looked at me in a way that said “Well Doc, what’s wrong with her? She’s suffering…why don’t you fix it?!” I know nothing, I have nothing, not even a blood pressure cuff or a stethoscope. Useless. After it became clear I had no magic to work, the nurses talked with her for some time and when I looked up I realized they had all started praying and they began to cry. Still weeping, we all left the little room and one woman sobbed something that made the rest of the nurses cry even harder. They told me that she had begged for something more to drink.
Its situations like these that make the conditions of these people’s lives so unbearable to witness. It’s incredibly emotionally draining and frustrating to visit these people and be essentially powerless to help them and also to be aware that there are countless more cases of this sort of neglect and suffering. I desperately wish I had any kind of training to actually make a difference out here beyond butchered Zulu greetings, a sponge bath and crackers…

-

Over the weekend, we finally got out of Durban and drove (left side of the road) three hours north to St. Lucia, a town surrounded by an estuary. Once again we stayed at fantastic backpackers, one was in the middle of town and the other was near the game pack isolated deep in the African bush.
The first morning we woke up before sunrise to drive to the Hluhluwe Game Reserve. We arrived just before the gates opened and the sun peaked over the hills that we imagined were covered with African wildlife. But we had no idea exactly how much of it we would run into. No more than a few kilometers into the park a pair of huge elephants walked right across the road literally a trunk’s length from our cars. The early morning continued with similar luck, we saw all of the big five except the cats up close, along with many of the other famous Lion King cast. Although we were bummed not to see the sought after lions or leopards, I think everyone was satisfied with their African encounters.
We spent the next day at the tip of Cape Vidal after a long drive through the estuary. The beach was pristine and the most beautiful I’ve seen here. The warm currents of the Indian Ocean carried white sand to this shoreline and made for a wonderful place to relax in the waves. On the way out of town we took an estuary boat tour which gave us views of hippo pods, crocodiles and many bird species that littered the sunbathed and plant filled waters.

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24 September 2006 @ 10:14 am

Week 3 - William Clark Orphanage

The William Clark Orphanage was the setting for our third Monday in South Africa and serves just under one hundred kids segmented by age. The women in charge were expecting us for a change and glad to have us there. We got a tour through the grounds, trying our best to dodge the screaming and laughing land mines in order to keep up with the nurse. Well, we didn’t get far before this tactic failed miserable and we were hugging, carrying and throwing the toddlers into the air. I felt like a walking jungle gym.

Over the rest of the day, we did absolutely nothing medical related and I loved it. We read books to the kids, taught them hokey-pokey (which I had no idea I knew well enough to teach) and then ventured outside. We played keep away with a soccer ball, reached unbelievable heights on the swing set and I became the hideous monster stalking my screeching toddler prey from beneath a high wooden playscape. This happily lasted for hours, its appeal never fading – by the end I needed the break more than they did. We helped feed them all lunch and herded them into their tiny beds until we were kicked out by the nurses who blamed us for keeping them up.

These kids were so remarkably joyful and healthy for everything they’ve gone through, we were told one little guy starting life dumped into a township outhouse. Throughout the entire day the kids would run up to me with arms in the arm shouting “Ba Ba” which I first assumed meant “Up! Up!” until one of their nurses corrected me laughing, “It means Father”. Its unbelievable that these kids must grow up in this way, without a family that so many of us take for granted, and that the world can be so harsh to so many.

“Some of the children that come here are terrified of grass – they’ve never been exposed to grass.” ~Michelle Peter

We spent several days at William Clark, in and out of the different wards getting very close to the kids. I spent one day working in the special care unit that housed the disabled or severely ill children. Using my digital camera to take photos of the kids in this ward, I got everyone working on colorful name tags to hang above each child’s bed. One girl couldn’t quite manage the painted hand print that went beside their mugshot, name and birthday but a foot worked just as well.

The rest of the week we were stationed at Cato Manor poly clinic. For an illustration of poor government health administration and misappropriation of funds there is no better comparison than KwaMashu and Cato Manor. KwaMashu was an overwhelmed facility that served a massive and diverse patient base with a relatively adequate and dedicated staff. They struggle to provide the required services mostly due to the lack of resources and competent administration. Cato Manor on the other hand is a brand new complex with an untouched operating theatre, x-ray and ultrasound lab, and surgery recovery room fully stocked with equipment that has yet to be uwrapped. They close around noon everyday because there just arent any patients. Its this type of obvious discrepancy that so clearly illustrates the faults in the government's allocation of healthcare funds.

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17 September 2006 @ 10:13 am

Week 2- KwaMashu

The second week of the program had us stationed at a large public clinic that served the township KwaMashu and the surrounding areas. My first impression of this place was one of total chaos – patients lined the halls and the various departments and consulting rooms formed a border around all those who were waiting. I still struggle to understand how they can possibly run a place organized like this.

The doctors here were obviously stressed and underpaid but they were again very open to our company. The eight of us rotated throughout the clinic, touring wards, eavesdropping on consultations, watching minor operations, and working with nurses in pediatrics. We had reoccurring issues with the doctors, nurses or patients misunderstanding who we were and what we were qualified to do. Every time I walked through the waiting room people would look up with pleading eyes saying, “Thank you for coming today Doctor” or “Sawubona Doctor, can you help me?” or “I must see you Doctor, my daughter is very sick.” The white coat we wear carries with it a heavy burden that I regret I cannot yet fulfill, everyday I wish I had more training so I could do more for everyone I meet. Instead, most often I just have to sit back and watch, it’s indescribably frustrating.

The differences in the South African schooling system have been an important factor in miscommunication about us as students. In this country students go straight to medical school after high school, so people our age would be just finishing medical school and well versed with a clinical background and experience. I know a lot about anatomy and physiology and too much about organic compounds, but I have almost no experience in diagnosing disease or drawing blood. The other students and I were repeatedly offered the chance to insert IV drips because the nurses assumed we’re trained, but I felt uncomfortable inflicting my incompetence on innocent patients. “See one, do one, learn one”…we’ll see.

The latter half of the week I got a chance to join the nurses working at the Mobile Clinic and drove with them far out of the city into the rural areas. It was the first time outside of Durban since I had arrived and the fresh air was a welcome change. After many miles along dirt roads we reached a small concrete building nestled in the brown hills surrounded by farmland. The Opesweni Rural Clinic served mostly mothers who carried their children for miles slung across their backs, administering immunizations and general check ups. We also had a chance to rotate through the satellite clinics embedded throughout the township and got to know the doctors very well by the end of the week.

“In the womb we develop our heart first and then our brain. To be successful in medicine you must also lead with your heart and let your head follow.” ~ Dr. Govender

This weekend all the students and I decided to stay at a backpacker (hostel) in town, it was situated on the main road of the richer (therefore safer) part of town just a walk away from the beach. Tekweni was a mish mash of three buildings with a small bar, full kitchen, central patio and even its own little pool. Everything was either painted or decorated, bursting with unrefined Africa-ness, yet somehow the place reminded me of Eugene. All the people we met were just the characters I had expected and the whole weekend got me excited for my post-program travels.

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10 September 2006 @ 10:04 am

Week 1 - King George

Multi-drug resistant tuberculosis is probably the most threatening disease for an American student because it is so easily transmitted, difficult to treat and so rare in the US we have zero immunity. So of course, we start our first rotation in the MDR TB wards at King George Hospital. The unorganized character of this program surfaced when the now eight of us were dropped off at the front gate of a hospital where the medical manager had not yet arrived and we were later passed off to already over-worked doctors who understood nothing about who we were or what our program was about. Despite this, all four of the doctors that I met at King George were extrordinarily kind and receptive to our presence. When another U of O student, Sara, and I arrived at the female TB ward, we fumbled for our masks knowing that we were walking into one of the most infectious places in South Africa. Yet we were met with looks of fear and hesitation from the patients and confusion and distain from the nurses.

South Africans have a strong stigma against any kind of mask because most terminally ill patients become oxygen dependent in their last days and it therefore becomes associated with abnormality or death. This reaction coupled with the awkward impairment of my communication ability (already a problem without muffling) caused me to pull the mask off. After a few rounds, the doctor finally advised us to wear the them anyway, he said most people that work here have had exposure already but are more resistant than we would be. It was still a struggle dealing with the masks, especially in pediatrics where the only way to interact with these extremely sick children was through facial expressions and sparing contact. Already alien, I can only imagine how scary we seemed hidden behind these terrible masks. It’s been unbelievably difficult to remain emotionally detached from these poor kids. I knew I was going to encounter tragedy like this but it’s impossible to prepare yourself or even comprehend the level of sadness that results from being impotent against an illness that is killing innocence. All I could think about was how they hadn’t even had a chance yet, they had just started life…and now this is how they must live?! More than once I had to step out of the ward, for the first time in a long time not in control of how I felt.

It’s not all misery, there were some incredible miracles, smiles and happy endings that occurred in our short stay. I was leaning over the barred beds of one toddler, trying to play with him the only way I knew how. Rolling my eyes and scrutching up my face I was astonished to see this little guy follow my every move with his own tiny impression followed by a beautiful baby giggle-gurgle. After several tireless minutes playing this game, the pediatrician came over and told me the boys story. He had a severe neurological TB infection, dramatically shown on a cat scan by several dozen dime-sized lesions deep within his brain. It’s unbelievable enough that this child is alive, much less responding to therapy and now interacting with me in this way. Only stories like his make this all bearable.

Over the rest of the week, we attended the out patient clinic, psychiatric department and operating theatre. The last day we joined the doctors for their x-ray meeting where they discuss their most challenging cases. As they poured over sparse charts, tied together with yarn, the doctors taught us much about the TB situation in South Africa, from complex drug regimens and lab tests, to the social and political aspects affecting treatment success. Dr. Osbourne told us that they see about a third die, a third cured and a third default. I’m just starting to get a picture of how frustrating it must be for these doctors. They are fighting a worsening epidemic without the resources or infrastructure they need. Ultimately, they have to send home those that fail treatment, causing the worst strains to spread and eventually pack their clinics with cases they cannot cure.

“We live in Africa, there's always total confusion. I promise you.” ~ Dr. Oswald

Over the weekend the other students did our best to break into the Durban night life. There’s only a handful of safe places to go at night and we managed to explore quite a few. It was entertaining to think that we were now the random foreigners with the goofy accents asking for drinks no one had ever heard of here. Of all the things we had run across in Durban, I was surprised to find that the bar scene may be the best preserved relic of the apartheid. The first bar we went to I again blended with my racial surroundings. It actually made me feel uncomfortable, I had gotten so used to being around those with darker skin – I no longer stuck out. The next night we went to a bar and casino on the beach and again I was the only white guy for kilometers, except this time in an ocean of only Indians. It’s an interesting experience getting a totally different perspective on the race issue and it has already taught me a few valuable lessons which I would be hard pressed to find in the States.

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02 September 2006 @ 08:00 am

Week 0 - Here we go...

I woke up the first morning to Busta Rhymes and Destiny’s Child blaring on the living room stereo. When I stumbled out of my room I was greeted by the round, smiling faces of my new siblings dancing and munching on Cornflakes as they got dressed in their school uniforms. Their casual welcomes told me they didn’t seem to mind the gawky pale giant now sharing their home. Not exactly the African morning I had expected.
I had arrived in a daze very late the night before after an eventful, but suprisingly smooth, 24-hour journey into New Jersey, across Manhattan, over the Atlantic Ocean and down to the southern tip of Africa. After my new brother and sister, Sithabile (10f) and Keith (14m), ran off to school and Zandi had started hanging up laundry, I took a much needed bath. Yes, bath – the first since I left elementary school. Lets just say that I soon rediscovered the many hygienic and geometric reasons that made me abandon this technique in the first place. It’s going to take some getting used to…

Over the next few days I met the other students and managed to explore the neighborhood a bit. The only other guy, Jasveen from UCLA, and I managed to wander our way to the closest shopping center. We were told it was past a “robot” (street light) near a “garage” (gas station), it took us a while, but when discovered the mall contained an internet café, grocery store, pharmacy and a currency exchange outlet – definitely a home base for the stranded Americans. We arrived home to meet up with Jasveen’s family, Zodwa, Midget and Makabongwe (I wish you could meet this kid) and kicked around a soccer ball with all the whole neighborhood. I get the feeling we’re a definite entertaining oddity. As evening approached, my host mother, Ntombi, arrived home from King Edward Hospital, where she works as a nurse. Dinner was served in a bucket…a KFC bucket – what really got me was when they asked if we had Kentucky Fried Chicken “on that side”, meaning in the States (one of which is actually Kentucky).

Our first assignment for the program was to find our way back to our neighborhood, Woodlands, from our meeting with the coordinator and medical director in downtown Durban. A stressful prospect if you know anything about Durban transportation or the trouble you can literally run into on the city streets. Luckily, just yesterday Jasveen and I had gone on almost the exact same trek, but aided by the invaluable guidance of our host brothers Keith and Midget. These fearless kids had guided us across busy multi-laned roads, through vacant lots and into street markets until we emerged on the beach front. The coast of South Africa is magnificent and the Durban beach could very well be mistaken for Miami if it wasn’t on the opposite side of the globe.

After an afternoon of wandering along the boardwalk shops and strolling across the sands of the Indian Ocean, we once again journeyed into the city to catch a taxi home. Careful, this is a South African taxi we’re talking about, which translates into a converted VW van packed to the brim with upwards of 20 bodies hurtling at unregulated speeds through traffic, honking the whole way to attract more passengers – to cling to the roof I can only assume. But anyway, they only cost about R3,50 per ride, about 50 cents. We made it home safely thanks to our host brothers’ native street smarts.

So armed with this borrowed expertise, on orientation day Jas and I led the group through the crowded city, even stopping at a few spots we had uncovered the day before – including a huge shopping market (The Workshop), the Museum of Natural History, and a place on the harbor for a few drinks (The Bat Centre). Throughout the entire day, and for the past week as a matter of fact, I have been the only white male within sight the majority of the time. In most of the places that we’ve gone we’ve only encountered a handful of white South Africans. In places in the city like the Workshop, hospitals and even my own neighborhood, I fit in about as well as an ostrich in Antartica. For the first time in my life I’m the definite racial minority. So far I’ve had no problems and actually kind of enjoy being the ethnic odd one out for once.

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