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.

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:

Sometimes it's difficult for me to believe that this is my life.

from: thomas cannell (xxxx at gmail dot com)
to: ben bearnot (bibearnot at gmail dot com)
date: May 15, 2007 1:04 PM


also, please find attached a picture of you with lutheran women holding a lutheran hymnal.

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from: ben bearnot (bibearnot at gmail dot com)
to: thomas cannell (xxxx at gmail dot com)
date: May 15, 2007 2:13 PM


tom -

it is clear to me that you wrote this e-mail expressly for the purpose of getting it posted on my blog (for all your family to see). nicely played, my friend; nicely played. see you later in the week - enjoy the hustle and bustle of 'maritzburg until then.

b

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Jo'burg zoo, dinner, party pics (and one beer parrot)

beer parrot!

Sunday = Beachday

I'm off to enjoy a lovely day on the beautiful beaches of Durban. We have tended to mostly hang out at one particular stretch of beach maintained by a resort/casino (with an awesomely fake Art Deco facade) right on the water - but I'm thinking that we might try and mix things up today. Some beaches have reputations for being safer than others - but when you're with a group of people and there is always someone around to keep an eye on your stuff, I don't think it makes too much difference.

Oh yeah, and I'm growing a beard. For now. (My brother, Ed, will probably write me to tell me it looks uneven or something. But because I've preempted him, he's going to have to find some other way to make fun of my facial hair.) Here's a pic, since I'm sure you guys are all so interested.


I'm going to go throw on my board shorts and split. Maybe I can muster something more substantive after a few hours of rejuvenating body surfing and beach reading.

When the going gets tough

I imagine that you can tell from my post earlier this morning that I've been struggling a bit over the past few days. It's not always easy living far away from the people, places, and things that you consider Home - but I am trying to tell myself that these are equally valuable parts of this experience.

In a last-ditch effort to increase the weekly Joy Quotient of STAB I was going to upload some of the devastatingly cute pictures of the kids I help teach basketball to on the weekends - however, the Blogger site doesn't seem to be accepting uploads at the moment, and I've maxed out all of my Flickr bandwith for the month. So, you'll just have to wait on those pix for a little while. Uhhhhh, looks I'm a big liar. The upload script seems to be working just fine now. Enjoy the pictures (I'll try to get some more good ones when I go out with the PeacePlayers International guys again next week) and have a lovely weekend!

What time is it? GAME TIME!

addendum:
I think the picture problem has been fixed. But please let me know if you're still having trouble viewing the pictures. And, as always, there are more pix posted up on my Flickr page. Thanks for bearing with me through technical difficulties!

Hey All -

This past weekend was spent with Junne and David in the the Hluhluwe Umfolozi Game Reserve (that first word is pronounced 'shuh-SHLOO-wee'. oh, that crazy zulu language.) in the northern part of the KwaZulu Natal province. For those interested in the geography, here is an excellent map of where the game reserve is located relative to the rest of the country.

We saw many spectacular sights and managed to get many nice (and a few excellent) pictures out of it. However, I was frequently struck by how the process of taking pictures can seriously detract from original experience. Spending time looking through a viewfinder - or at an LCD screen as is the case with most digital cameras - means that you're not spending time taking it all in with you own eyes. This is problematic, to say the least, but I tried not to let it get me down for too long.

So, without further ado, some pictures from Hluluwe.









And one picture of your intrepid traveler, just for good measure. How pensive! How brave?!



I'm out for today, but I'll be back for more soon enough. Until then...

Some early adventures in Durban

There are just so many things to write about; my first two and a half days here have been so incredibly full of activities. Malcolm ‘Mally’ Roselt, who owns the house I’m living in, is a most gracious host, driving myself and the other borders around to see many sights in and around Durban. He is currently hosting four people at his house, including myself. There is a lovely couple from Harvard Medical School – he’s recently finished his MD and she’s in the middle of her MD/PhD – and the fourth is a family friend of the Roselts. There will be more on the family friend, Casey, later; suffice to say for the moment that she shared her strong Christian and Creationist convictions with me yesterday evening, simultaneously mystifying and intriguing me. (Suffering from a rare bout of Tact, I decided to keep my big mouth shut about my own personal beliefs. But, because I can’t help myself, one choice comment from last night: “There is not one shred of conclusive scientific evidence to prove that evolution ever happened.” ??!.)

I have managed to take some nice pictures with my new digicam over the past few days – and so I think I will spare you from my more of my boring thoughts to present you with the following photo essay of the exciting places I’ve traveled to yesterday and today.

Yesterday morning Malcolm dropped me off in front of uShaka Marine World – an incredibly kitchty Sea World knock off, designed to look like a traditional Zulu village (Epcot Center, eat your heart out)





It seemed a bit depressing to pay 100R (current conversion rate: 7R to the 1$) to go see the dolphin show by myself, so I just walked through the shopping center out to the Indian Ocean. Here was the view I was graced with as I got beyond the last store. It is very difficult for me to believe that this is actually a picture of the city where I am currently living.



Pretty awesome, right? I walked down to the beach, dipped my toes into the warm blue water, sat down on my towel and read for a while. After I had been sitting out there an hour or so – and getting fantastically burnt, it turns out – an Indian man toting a woven wicker bag along the beach offered me food. Now, I’m not usually squeamish about eating Street Food, however, it took me a little while to muster up the courage to fork over the 5R for a container of potato curry. I figured the price was low enough that I wouldn’t feel guilty if I decided to pitch it. Final verdict: potato curry from the beach man = sketchy, yet extremely delicious. Here he is hawking his delicious wares to other people on the beach. “Want eat my curry? Eees delicious. Frresh dis mahning.”



And this morning we went out the Victoria Market, a large, semi-outdoors marketplace in the middle of the city, highlighting the Indian influence in the city. Here I am in front of the market with David, a resident at MassGeneral in Boston who is working at the McCord Hospital and living with the Roselts during his month in SA with his wife, an MD/PhD student at Harvard.



We walked around the market, looking at all of the beautiful sculptures, utensils, jewelry, and plates made from reappropriated Telcom telephone wire.









Then, I saw these out of the corner of my eye:



What the hell could they possibly be? Zulu condoms!



That’s funny – but not ‘ha, ha’ funny. It ‘s quite sad to see these being sold in a country with a 20-25% AIDS rate, where the Deputy President recently testified (as a defendant in his own rape trial) that he believed that HIV could be prevented by immediately showering after intercourse. There were lots of other exciting goods being sold in the market place.

Alright, I have completely run out of time here. I'm sorry I have to leave you so abruptly, but you should definitely go take a look at the rest of my pictures in my Flickr stream. In general, I've been doing really well, and I'll try and post again from the McCord Hospital soon. Tomorrow is my first day of work! I'm pretty excited.

b