Quick pix

Crooked and blurry as it might be, this picture made me smile broadly when it arrived in my inbox late last week. The e-mail this photo was attached to was sent by the main secretary at the McCord Hospital in Durban, South Africa -- where I worked in 2007 -- and included a request for the name of the then-med student on the far left. In writing my response to Geraldine, I was overwhelmed by how much I miss Durban and all of the people I worked with at McCords. It's going to be very hard to resist the urge to go back during the summer after my first year in medical school. Hmm -- I was planning on writing a bit more about South Africa, but I think I'll just stick with nostalgia for the time being.


Big ups to Drs. Richard Murphy, Ingrid Bassett, Helga Holst, and Janet Giddy for featuring so prominantly in this picture. And why do I look like a giant? Weird.

Here I am / Morocco you like a hurricane

A quick and dirty assortment of pics from my trip to Morocco. Morocco is a wonderful - if sometimes bewildering - country and we had a fantastic time during the two week vacation. Our days were filled with of beautiful medieval architecture, magnificent wood/stucco/tilework, delicious food, and more shopping than any person on a student budget should admit to.

In no particular order:
















Lots of interesting things to think about on this trip -- my first into Le Monde Arabe. Maybe I'll take some time to write these thoughts/ideas/uselessobervations down and post them up here. I'm supposed to start my work at Bellevue hospital this week, which would make this difficult, but the paperwork processing is taking far longer than expected. In any case, you'll all be hearing more from me soon. Holler.

Let's begin here.

On my way home from South Africa, I stopped in London for a week-long crash course in Reimmersion. Everything was outrageously expensive, the weather was cold and grey, but a long day at the Tate Modern made it seem worthwhile.

The piece currently occupying the main hall is called Shibboleth, an installment by Doris Salcedo. Here's a decent article about the work - which essentially looks like a giant crack running the entire length of Turbine Hall - from Time Out London.

I found Salcedo's thoughts about hidden racism and segregation in the developed world particularly thought provoking having arrived directly after a year in South Africa. 'Shibboleth' is also a specific comment on London - a place thought of as multicultural, inclusive and ethnically diverse. From an interview with Salcedo: 'You have on one level a society that considers itself homogenous, but I've been wandering around, visiting estates near here, and the [global] north/south divide is very evident.'

And here are some pictures of the I've collected from around the web:

The Tough Questions

We had taken two different propeller planes to get up to the clinic in the Ubombo District, near the Mozambiquan and Swaziland borders. A few doctors from the hospital I work at in Durban travel up here twice a month to assess particularly difficult clinical cases and check up on ongoing research projects. I had been lobbying to go on one of these trips for a long while, but the size of the tiny planes we flew in – 9 and 4 seats, respectively – had made it impossible for me to tag along until this week. Dr. S needed a hand capturing some viral load and CD4 data for a group of patients with probable HIV mutations.

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When the girl first walked into the consulting room, it was hard to tell how old she was. This is a somewhat common feature of HIV positive people on antiretroviral (ARV) medications. The drugs – especially those still being used in the developing world – often have a metabolic side effect that causes your body to redistribute fat away from your limbs and face. The condition, called lipodystrophy, occurs less frequently amongst those on second- and third-generation ARV regimens, gives the appearance of premature aging.

After opening up her medical history and jotting down her name, I saw that she had just turned 13. The rest of the notes were even more sobering: she had tested positive in 2005 at 11. I tried to come up with a list of reasons why anyone might seroconvert around that age, quickly throwing up a series of red flags in my mind. Too many of the possibilities centered around the South African realities of forced or coerced sex.

Fortunately she had been tested early, received good care, and had started taking a three-drug ARV regimen as soon as possible. She had been taking ARVs for nearly 2 years now, and was virologically failing her first line regimen. Her viral load had spiked over the past few months, indicating that the virus had become resistant to her current treatment.

This happens for reasons that can be generally grouped into one of two larger categories: inadequate regimen (e.g. prescribing error, resistant bug, malabsorption) or poor adherence (patient non-compliance for any number of reasons). We needed to figure out which camp this girl was in. With laboratory results being difficult to come by in this incredibly rural clinic on top of a mountain in the middle of Zululand, a patient interview to exclude the poor adherence possibilities seems to be the best way to proceed.

The nurse translated as Dr. S started asking questions to the girl and her Gogo (Zulu for grandmother, with or without blood relation) to try figure out what might be going on. “Who gives you your medications? How many pills, how many times each day? Does anyone at school know you are taking ARVs?” These are pretty standard questions to test for pediatric adherence, and it usually becomes obvious when the child isn’t adhering their treatment. The girl seemed confident in her answers to each of these questions, and I thought we were done with the interview.

Dr. S, however, proceeded to take his questioning in a direction I wasn’t expecting: “Do you know what these drugs are for?” I had been copying down the girls’ labs values into my notes, but as the question was asked I froze and slowly looked up. The girl looked to the nurse for a translation and paused for a while before slowly nodding her head. Dr. Sunpath stroked his mustache, unconvinced, and asked one final, heartbreaking question: “Do you know what you have?”

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I don’t know if the way Dr. S phrased this final question was quite sensitive enough for the situation, but his line of reasoning was exactly right. I think we also disagree about the information contained in the girl’s final answer – I assume she knows less about her HIV status than Dr. S does – but it was an incredibly powerful moment to experience in person.

The rest of the consultation finished up quickly. Dr. S recommended she come back in three months’ time for some new viral load and CD4 studies, and to reassess her clinically. As the nurse pulled the door closed behind the girl, Dr. S and I placed our pens down and put our palm flat on the table, as if to steady ourselves. After a few deep breaths, Dr. S spoke: “Could you send in the next patient please?”

From the flight home:

Back in the Saddle

I'm hoping that this post will kick off another prolific period in this blogs' life. I was tempted to call it a Golden Age, but quickly realized that it was just the episodes of Rome (which I been compulsively watching) talking.

There are so many things for me to put up here in the coming days. Wonderful pictures from our trips to Cape Town, Hluhluwe Game Reserve, and one of the big Townships around Durban; articles from the New England Journal and the Times about relevant public health issues; reflections on life here in SA as I realize that I only have a few more months left to spend; musings on exciting new music that I've stumbled upon in the past few weeks.

So, I guess that this post is just to let you know that I am back. From the number of unhappy e-mails in my inbox, it seems that I was missed - but I will do my best to fill in the missing pieces.

I'm sure this won't be the last you'll hear from me today. Please keep your Google Reader (or whatever RSS reader your prefer) refreshed and hang on, as a torrent of posts are headed your way.

And as a teaser. Two pictures from yesterdays' graduation party in Umlazi:

You think you know, but you have no idea

I think I'm little burnt out after writing up my first day of the conference, along with putting together all of the materials for my first paid assignment(!). I think I should hold off on Days 2 and 3 of the SA Aids Conference for the time being. I'll likely volunteer to put together a short presentation for some people in my office (many of whom weren't able to go because of the great expense of conference passes), and I will pirate some material from that to put up here.

Oh yeah, I have those pictures that I just uploaded to Fickr. Those of you who read my feed in a RSS reader have probably already seen some of them, but I never put them up here.

These are some pictures from 3 different events last week: the Bafana Bafana soccer match, the Peace Players International City-Wide Tournament, and George's birthday. I think you should be able to figure out which pics are from which event.

Round 2: Amphitheatre

Day number two in the Northern 'Berg entailed a serious hike up onto the top of the Amphitheatre, a huge rock formation that rises a nearly kilometer above the surrounding terrain. At the top there was some snow, some killer views, and a series of chain link ladders to lead you down nearly 15 stories of sheer rock face to the path back to the base area. It was a blast, and reminded me how much I love to spend time outdoors doing some intense hiking. The weather was quite crisp in the morning and evenings (hence the heavy jacket), but during the middle of the day we couldn't get our layers off fast enough - and I even came back to Durban with a nice suntan.

But, enough of my blathering; I think I would be best served by letting my pictures do the rest of the talking. Just in case you notice some glaring discrepancies between pictures: some of the pix were taken by Lara's beautiful Cannon Rebel SLR, replete with many fancy lenses. And, as always, a whole bunch more photos can be found on my Flickr site.

Round 1: Lesotho

This weekend away in the 'Berg was lots of fun. Our first day was spent touring around a few villages in Lesotho, led by a very interesting guy who introduced himself as "Power" (for effect, he flexed his muscles when he said this). He's a middle school Maths teacher at this school just on top of the edge of the mountain, and was an amazing guide. He was very knowledgeable about Lesotho's history and was interested in making sure that he took time to answer any questions we might have before moving on to the next place.

First he took us to his school and showed up the dedication plaque on the main doorway. The school was one giant classroom - although they are raising funds to complete and partially-finished second building - housing 150 kids in 4 or 5 different grades. Each grade sits in desks facing a different wall, and the teachers rotate from class to class throughout the day.



These are some kids that were hanging around the school property. I think they're probably a bit too young to attend, but are extraordinarily cute and deserve many pictures being taken of them.


Then Power took us to the 'local brewery' - which simply means that he has this friend who brews traditional Basotho beer. It was delicious, although passing around a giant coffee can-looking container wasn't exactly the most hygienic option. I got a couple of good chugs in when it came back around.


Then we hiked up one of the local sandstone rockfaces and ate our lunch with a killer view. In looking at this picture, it seems that everyone else decided to wear boring colors that day. I'm keeping it real in the bright green.


Another picture of an extremely cute child!

And, finally, we got to spend an hour or so with a Sangoma - a traditional healer. She didn't speak a word of English, but was a riot nonetheless. Power translated for her, but as the pictures below demonstrate - awesomeness needs no translation. Her 'specialty' as a healer: Male Problems. Which sort of explains why she has 10 kids (and 33 grandchildren).

All jokes aside, she was very interested in sharing information about what ailments she can and can't treat, how she became a Sangoma (her Ancestors spoke to her in a dream - which is an honor that you aren't allowed to ignore in Basotho or Zulu culture), and how she treats different illnesses. All of this provided me with a lot of new information about Southern Africas' widely-practiced healing traditions.



And just because everyone loves a good Group Shot with some striking vistas in the background...and some serious studs in the foreground.


I also have some good pics from the hike we took up to the top of the Amphitheatre the following day, but upload speeds are slow at the moment. So, I'll take a break for dinner and some work - and I'll try to get up some of those other photos soon. Later.

Be jealous; be very jealous.

I now present to you some gorgeous pictures of a Cape Town sunset. (A big thanks to Philippa - a friend of mine who has left McCord to return to her life as an Intern in the UK - who took these photos while sitting on her parents' deck in C-Town.) And I think I'll save the rest of what I have to say for another moment.

At long last, here are some pictures from my trip to Lesotho last weekend. It turns out that some of the best pictures were taken with other peoples' cameras - some of which I've been able to get my hands on, and some I'm still awaiting receipt of.

As I've mentioned in all of my previous posts about Lesotho: it is a country with the most striking scenery. Huge mountains, blue skies, and green fields all contribute to Lesotho's natural beauty.


The huts in small town of Semongkong are built of stones with expertly thatched roofs


and these little corrugated tin (or is it aluminum) shacks comprised the vast majority of the commercial district. Each one was it's own small business with a hitching post outside for patrons to tie up their horses while they shopped.

Just 10 kilometers into the mountains from Semonkong is a 200+ meter waterfall plunging into a mountain stream. The rains hadn't yet come to Lesotho while I was there, meaning that the falls weren't as torrential as they might otherwise have been - but it was quite beautiful nonetheless.

It seems that all the stores in the whole of the country carry the exact same items. It was quite surprising at first, given that I'm living in a city in South Africa where - much like in the US - we are never at a loss for choices of brands/products in supermarkets. However, once it was explained to me that each of the towns are on one long supply route, with most of the goods being imported up through the difficult-to-navigate mountain passes, it all started to make sense. This reasoning also seems to explain why goods became more expensive as we moved further outside of the capital city of Maseru. More difficult destinations on the supple route = greater transportation costs = greater costs of goods for consumers.


On the way back down from Lesotho we were able to spend some time with a few of the shepards who were walking their sheep across the road as we were driving past. Many of the shepards were quite young, but were dressed in the Basotho uniform of rubber galoshes and a blanket of synthetic material wrapped around their shoulders to keep out the cold.



And if you are interested in looking at some more of my pictures, you can find them on Flikr,
or you can always e-mail me directly. I'm starting to take pics of my new place for everyone to see. Hopefully I can post them in the coming days.

Talk soon.