Stranger Than Fiction

I had been hearing rumors about this story for the past few weeks, but it was only over the weekend that I saw the first written confirmations in the mainstream media. As a disclaimer, my source at St. Mary's Hospital on the outskirts of Druban tells me that this problem is not as widespread as these articles might have you believe.

And now - without further contextualization - a distinctly South African story of crime and drug use (from AFP.com):

S.African criminals steal anti-AIDS drugs to smoke with marijuana

Wed May 16, 3:29 PM ET

South African criminals are rumoured to be robbing AIDS patients of lifesaving anti-retroviral (ARV) medicines to smoke with marijuana for a better high, a local hospital said Wednesday.

St Mary's hospital in Durban in the eastern KwaZulu-Natal province said patients and staff have reported ARV's being stolen for this purpose.

"The community outreach co-ordinator of our ARV programme did confirm ... that on average twice a month she receives reports from patients that their anti-retrovirals have been stolen, either at knifepoint or snatched from their hands," hospital chief executive Dr Douglas Ross said in a statement.

AIDS lobby group, the Treatment Action Campaign (TAC), has warned against smoking Stocrin, part of a triple therapy cocktail given to patients, and reported to be the drug being being abused.

Stocrin was a "very toxic drug", TAC spokeswoman Lerato Maloka told AFP.

"Stocrin affects the central nervous system, it is recommended that people who have depression or psychotic illness shouldn't take Stocrin as it will make the condition worse," she said.

People using the drug could experience side effects like dizziness, nightmares and hallucination.

"People of all ages are stealing it (Stocrin) from patients and smoking it together with dagga," The Saturday Star quoted community worker Nancy Sias as saying.

"They say it gives them a better high than Mandrax and it makes them feel dizzy, weird and have wonderful dreams."

Ross said the hospital was encouraging patients to conceal their medicines in public to minimize the risk of theft.

"We have replaced the medication of those whose medication was apparently stolen."


For more coverage, here is a link to an article in this week's Mail and Guardian:
Thugs smoking antiretrovirals 'with dagga'

"Let's go Sharkies"

Today is the Final of the Super 14, and Durban is buzzing. Don't know what the Super 14 is? Only one of the most competitive international Rugby leagues in the entire world! Still doesn't ring any bells? Well, people Love rugby here, and the Durban Sharks are playing against the Pretoria Bulls in the Super 14 Championship Game in what the local paper has dubbed the "All-South Africa Climax". Heh.

I went to buy some new running shoes (takkies if you're a South African reader) this morning and after picking out a new pair of Brooks kicks I asked the salesman where he was going to be watching the game this afternoon. I wouldn't have pegged him for a rugby fan - he was small, with a runner's build - but he was wearing a Durban Sharks jersey. "You know that bar? It's over that side," waving his arm towards the door of the shop and across the street.

"Oh yeah, Jack Rabbits?"

"You've been? Ees good place to watch rugby. I see you there?"

"Yeah, I'll head over there just after I try out these shoes for the first time. Thanks guys, see you later!"

So I walked home and did a little work and then went out for my run. Along my normal route I saw 1. three cars with giant black flags emblazoned with the Sharks logo waving out the window 2. five men and two women wearing Durban Sharks replica jerseys 3. an episode of very excited honking when two cars sporting matching Sharks decals spotted each other from across the intersection.

Everyone seems to be very excited about this Final. It also seems to stretch across racial and economic boundaries in ways that few events seem to in South Africa. You get the impression that all of Durban is cheering on the Sharkies collectively, and it really has made the city seem like a unified and vibrant place. It's an exciting feeling.

I almost forgot to mention one of the best South African celebratory traditions that I was privy to on my run this morning: grilling meat before 11am. This morning I saw a street vendor selling boerewors, basically a giant and delicious Afrikaaner sausage, at 10:37 in the AM. It's a shame I didn't have any cash on me.

Now I'm showered and about to head off to Jack Rabbits to meet up with some ex-pat friends and the guy who helped me out with this awesome pair of shoes. I'm thinking it'll be fun. Just another sunny Saturday in Durban. Later.

Sometimes it's difficult for me to believe that this is my life. Part 2.

Here's an excellent article from the March 12, 2007 issue of the New Yorker written by Michael Specter that you all should read. It focuses on the Denial of AIDS and its deleterious effects on the efforts to combat the pandemic, particularly in South Africa. One particularly memorable quote to coax you to read the article:

"AIDS denial plays a corrosive role in the health policies of many countries, but South Africa provides the most extreme and enduring example. Five and a half million of the country’s 48 million people are infected by H.I.V. Today, only 200,000 receive AIDS drugs. In 2003, the South African government issued a comprehensive AIDS policy, but it wasn’t implemented. Mbeki has never disavowed his view that H.I.V. medicines are aimed at maiming Africans, and he’s never publicly acknowledged that H.I.V. causes AIDS."

The piece also contains an fantastic opening anecdote about a modern-day Sangoma (traditional Zulu healer) who claims that the cure for AIDS was given to him in a dream by his long-dead grandfather. The grandson now has a storefront in downtown Durban, which I am now hoping to check out in the coming weeks.

The article can be downloaded as a .pdf by clicking here. Let me know if that doesn't work; I'd be happy to send you the article directly.

Where science and public health do not intersect.

From a recently published article in the always excellent British medical journal Lancet:

“Infants who were breastfed but also received solids (generally home-prepared cereal or commercial infant porridges) any time after birth, were nearly 11 times more likely to acquire [HIV] infection than were exclusively breastfed children.”

Coovadia HM et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding: the first six months of life. Lancet 2007 [in press].

///

This article was written by Coovadia et al, a group based right here in Durban at the Nelson Mandela School of Medicine. This highly-relevant issue of whether children of HIV-infected mothers should or should not breastfeed is very interesting one both from a scientific and a public health standpoint.

It is counterintuitive for many (including myself) to imagine that an HIV-negative baby should be fed the virus-containing milk of its mother. Breastfeeding is well demonstrated to protect against a range of illness, but it is risky because of the opportunity for HIV transmission from an infected mother to her baby. However, the data from this extensive study shows that if the infant is fed EXCLUSIVELY breastmilk - and does not have any formula or other solid food - for the first 6 months of life, the practice of breastfeeding is very safe and greatly reduces the probability that the baby will become HIV-positive. The underlying science of this has to do with the fact that babies' digestive systems are unable to handle most other foods at this early developmental stage, leading to small lesions or gaps in the GI mucosa which leads to increased transmission of the virus when the baby consumes breast milk with a positive viral load.

However, the public health policies that will emerge from this finding are ambiguous at best. Working mothers, especially in the developing world, can't always make time to feed their babies on regular schedules. These women tend to work long shifts, travel great distances between home and work using public transportation, and often rely on other family members to help provide care for their children. Complicating this matter even further, baby formula is prohibitively expensive. The end result is that it is most convenient for mothers to feed their infants a mixture of breast milk along with other available foods in these resource-limited settings, dramatically increasing the likelihood that the child will become positive within the first six months of life.

Stopping the spread of HIV from mother to child is exceedingly important (for a whole host of reasons that I shouldn’t get into here), yet how can South Africa or the World Health Organization advise mothers in impoverished settings around the world to do what is essentially impossible? While the science underlying this paper is very strong, it is far less obvious to me – as well as to other members of the HIV/AIDS research community – what public health guidelines should arise from these findings.

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.

///

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

///

Writer's block (Don't call it a comeback/ It's been here for years)

I think I have been finding a bit harder to write than I was before. Coming up with (unprompted) prompts was working well for a few months there, but I've been far less prolific thus far in May. Maybe it's because life here is starting to pick up the pace, or maybe it's because I've been trying to avoid my computer.

There are lots of good things to write about at the moment, but none of them can seem to hold my attention long enough for me to give them a proper treatment. There are probably a half dozen unfinished blog posts in my documents folder at present. In fact, I just created a new folder to accommodate these partially fleshed out pieces. Maybe this public declaration of my difficulties is just what I need to kick me back into gear.

Hope you all had a lovely Mother's Day, and I'll be back with more posts - and possibly some pictures from this past weekend - in the near future.

B

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

beer parrot!

Three up and three down.

Sometimes life lends itself to lists. Or maybe I'm just lazy. Either way, here we go.

Cheers (things that are awesome):

My trip to Jo'burg with my friends. I'll post some fun pictures just after I finish with this list.

I decided to shave off that silly beard. NO MORE ITCHING!

We're almost done with the retrospective part of the TB/HIV study, and the US National Institute of Health has finally released the money for us to start enrolling patients prospectively after dragging their bureaucratic feet for the past 6 weeks.

Jeers (things that are wack):

I managed to get sick upon my return from Johannesburg. The confluence of a lack of sleep, too much partying, and multiple sources of intense stress has given way to a most excellent fever and an extraordinarily sore throat.

The Association of American Medical Colleges (AAMC) website doesn't support any of the web browsers I have on my computer. I will need to download and use antique versions of either Internet Explorer or Netscape in order to use their web-based Med School application.

Um, I've been lent the DVDs of the first two seasons of Grey's Anatomy and I just can't bring myself to stop watching. It's an incredible time sink and the show is pretty mediocre, even as far as doctor dramas go, but I can't turn the damn thing off.

Jo'burg

I don't have time to write very much at all, but I just thought I'd let you know that I'm off to Johannesburg (Jo'burg to South Africans) for the weekend with friends. I'm hoping that this trip will be just what I need - but I'll be back with a full report come Sunday.

Peace out.

Thinking forward, looking back

Sometimes I catch myself thinking about how I'll eventually look back on a particular experience in SA when I finally get back to the States. I know that it's not a particularly productive endeavor, but it often proves to be quite an interesting thought experiment.

Two unrelated examples:

Now: I assist a doctor with a lumbar picture, helping to hold an late-stage HIV patient in place and comfort him as the intern in his mid-20's withdraws 10 milliliters of cerebrospinal fluid to relieve intracranial pressure and test for cryptococcus (a nasty yeast pathogen) or significant protein concentration.

At the end of my first two years of medical school: That was first time I ever felt a patient flinch in my hands. He was obviously scared and was turned away from the from the doctor. He whimpered and jerked as the needle found the space between his vertebrae.

______


Now: I cruise around town in a manual, right-hand drive car.

When I get picked up at the airport in New York: Hey, why doesn't anyone here drive stick? And why is the traffic on the wrong side of the road? And where the hell did the view of the Indian Ocean go?