Back in America

After a 6 hour drive to Johannesburg, 2.5 hr flight to Cape Town, 11.5 hr flight to Amsterdam, 2 hr flight to Paris, 11.5 hr flight to Los Angeles, overnight in LA with Scott's sister Tara (took the best shower of my life), and a 2.5 hr flight to Seattle.... I arrived at SeaTac Airport on Friday, June 4th to be greeted by my Mom. What a trip!
It is easy for me to say that my three months in South Africa were unforgettable. The medical aspect of the trip was formative and confirmed my desire to be a doctor more than words can describe. The exposure to a variety of health care concerns, complications, and challenges will have a lasting effect on my future career in medicine. I recently read the book Better by Atul Gawande. Read this book. It inspired me to embrace a deepened attitude of diligence in all aspects of life. The author challenges medical students and people in all professions to simply work to be better. The margin of error that is deemed acceptable in most professions costs lives or leaves lifelong complications in medicine. Facing that reality as a medical student and making the extra effort to reduce that margin of error is imperative. I plan to take the memories of South Africa and the lessons of this impacting book to my new location in Portland as I embark on a new chapter of life: Medical School. I am moving on August 1st and beginning school on August 16th, oh the anticipation!

Last words to all my readers: Take advantage of all your opportunities in this amazing country. Most of us have the comforts of good health, loving family, education, financial stability, and the prospect of a bright future with endless possibilities. The reality is that most of the world can only dream of attaining these things. Some of you reading this are probably thinking.... geez Shanley, way to make me feel guilty for all that have or simply that this is old news to you. Well even if it is old news or makes you feel guilty, my intention is to kindly remind us all that we are lucky by birth, therefore we should appreciate it and make our world even better.

So I encourage everyone to go see the world, embrace differences, be uncomfortable, think differently, help someone, make someone's day a little brighter, challenge yourself, and in the words of Ghandi: Be the change you wish to see in the world.

Safari: Africa On Foot

Molly and I finished of our African adventure with an african adventure. We spent Sunday-Wednesday morning at the Africa On Foot Camp in Krugar National Park. At 5:30 in the morning we got our wake up call to grab some coffee and granola bars before heading out for a bush walk at 6:30. We spent about 2-3 hrs walking each morning. The walks focused on seeing the smaller highlights such as insects, spiders, birds, vegetation, tracks, and small animals like impala and mongoose. Then we returned to camp for a hearty breakfast. The rest of the afternoon was free time. Around 2:30 we reconvened for lunch before embarking on a game drive at 3:30. Our group of about 6 guests boarded the open air land rover and set off in search of large game. We would break for drinks half way to watch the sunset. Then the night drive began as we explored the pitch black night with a spot light in search of lions, leopards, rhino, and more. It was a fabulous experience to finish off our three month excursion abroad! Below are some highlights:

Vulture and an African Eagle (right) perched in a tree.


Our guides rifle, great protection!


Lioness at night.


Wild cucumber seed.


Me on the Land Rover.


The hippo we spotted in a watering hole.


Male bull elephant.


Another elephant that was part of the 30-40 elephant herd we saw.


We spotted a Kudu.


The Rooibos hut we lodged in.


A baboon spider hole.


Our guides leading the morning bush walk.


Beautiful water hole.


Male rhino staring us down.


Male rhino again.

Goodbye Durban, Hello Jozi

Our last week in Durban flew by. I celebrated my 23rd birthday on Wednesday with homemade lasagna, espresso brownies, ice cream, and wonderful company. Molly and I said our goodbyes to our amazing host family on Thursday night. The boys, Qiniso and Makabongwe, cooked a “braai” for us, which is a barbeque, to honor our departure.
On Friday morning we were dropped off at the Happy Hippo, a backpackers’ hotel. From there we got picked up by “Baz Bus” which is a backpacker transport system here in South Africa. We took a 10-hour scenic drive across Kwa-Zulu Natal, through the Drakensberg Mountains, and into Johannesburg. We could see Soweto stretching far and wide on our way in to Joburg. Soweto is the largest township in South Africa and home to “Soccer City” of the World Cup. Baz Bus safely deposited Molly and me at Brown Sugar Backpackers Lodge. We had a twin room booked for two nights at this hotel that resembles a castle and has quite eclectic décor. For example, above the entry way is a warthog head and on the other side of the wall is the warthog butt...
On Saturday morning, we made eggs and toast for breakfast down in the communal kitchen before starting our day. Molly and I are both battling sinus/head colds so we decided to have a relaxing day in Johannesburg rather then try to see it all in one day. We walked about 30 minutes to East Gate Shopping Mall. We bought tickets to see Sex and the City 2 and grabbed some coffee before the movie. I enjoyed a superb almond latte at Lattelicious (finally a good cup of coffee) and an almond croissant. Then, Molly and I grabbed some meds, orange juice, and vitamins at Clicks Pharmacy and went to enjoy the movie. On our way back we went to an African market to pick up a few last minute gifts. Then we enjoyed Won Ton soup and veggie spring rolls in China Town which was right down the road from our lodge. Tomorrow we catch a flight to Nelspruit to go on our three-day safari. On Wednesday night we start the long trek home. We are winding down into the last leg of our trip!

Malagazi Clinic

We spent the day at Malagazi Clinic run by the Islamic Medical Association. It is located near Umlazi Township and primarily serves rural, poor populations. Immunizations and family planning took place in the morning. Molly and I took turns giving immunizations and birth control injections. It was good practice for us!
The rest of the day was spent with patients presenting with flu, shingles, STI's, colds, and other common ailments. Molly and I were in charge of collecting medications to dispense and administering the injections... more practice!
Malagazi Clinic was similar to our Marianhill Clinic experience but far more hands-on.

Zodwa's School

Saturday was an action-packed day starting at 7 am! Zodwa drove Molly and I to Stanger, a rural town about 55 km outside of Durban. We picked up two other teachers along the way and arrived at her school. Thirty-one teachers educate over 1,000 learners in grades 1-3. Its an incredibly large school. Another school came to have an athletic fun day with the children. The kids did some socializing, singing, and introductions were made between the schools. The adults had some sandwiches before heading out to the playing fields. The teachers from each school formed teams and had a friendly match of Netball which is similar to basketball without bouncing the ball. One of the teachers fell and hit her head hard on the concrete surface. Molly, Zodwa, another teacher, and I accompanied her into Stanger to have her checked by a private doctor. She was given some medications, an ice pack, and sent home to rest.
When we returned we watched the boys teams battle it out in a soccer match. These kids were unbelievable at soccer! I finally understand the craze here, because these kids were better than any high school match I've been to in the States. Absolutely incredible little athletes. It was fun cheering on the kids and taking part in their victory over the other school.
We enjoyed some delicious barbecue or "braai" as they call it here. We helped pack up everything and left the school late at about 6. We spent a couple hours at Gateway Mall on the way home. It is a huge 4-story mall with everything you can imagine. Molly and I indulged in some soft serve ice cream, shopped a little, and strolled the entire mall.
On Sunday I slept in, finished a book, did some grocery shopping to make lasagna for my birthday on Wednesday, and relaxed with the family. One week to go!

Surgical Summary

Standing in front of the surgical board where they post the cases for the day.


I spent this week in Surgery. Surgery at King Edward is divided into teams and they work on different days of the week in order to divide surgical time. There is always a team on in-take which means they handle 24 hours of emergency surgical care. Molly and I bounced around with different teams throughout the week in order to make the most of our short experience.

Monday: After finding our feet in a new department, we hooked up with the gyne team. The elevators weren't working until about 10 am, so surgeries were quite delayed. We observed a total abdominal hysterectomy. The procedure took about 3 hours and was extremely interesting. At the end of the day we popped in the labor ward to see if we could watch a childbirth. We were in luck. Molly and I both had the pleasure of viewing our first child birth. WOW. It was an unbelievable experience! I commend all mothers after having observed a normal vaginal delivery.

Tuesday: I observed a tonsillectomy and adenoidectomy on a young girl, a zygomatic lift on a man who had sustained a fracture a month ago, and a laparoscopic cholecystectomy (which is the exact procedure I had two years ago). The most exciting procedure of the day was a soft tissue release and repair of a 4-year old who had a neglected club foot. The orthopedic surgeons were excellent teachers and explained the procedure thoroughly.

Wednesday: On the surgical menu for the day was a vaginal hysterectomy, genital wart cauterization, glenoid cavity fracture repair using a plate (the individual was shot, shattering his scapula and fracturing the glenoid cavity in half), mandibular fracture repair, and an open reduction internal fixation (ORIF) of a femur.

Thursday: I saw a femoral nail insertion which required a ridiculous amount of hammering! The nail is hammered down the shaft of the femur to secure the fracture. I also observed a right mastectomy on a woman with breast cancer.

Friday: Today a trauma patient involved in a road traffic accident came in to surgery. They repaired a tibial fracture and proceeded to repair a diaphragmatic hernia. After this lengthy procedure I observed an abdominal hernia repair.

This week was eventful in surgery! During our down time Molly and I would go check in on the kids in the pediatric ward, rock crying babies, and entertain the kids. It was a great week at King Edward. I am winding down to my last week in the program. I have to say I am looking forward to coming home!

Cute Kids

Fun times in pediatrics!

Weekend

Friday night we made popcorn with our host family and watched one of their favorite movies, Sarafina, with Whoopi Goldberg. The movie was about the student uprisings in Soweto, South Africa's largest township, during apartheid.
On Saturday I woke up to a very rainy day in Durban. Molly and I spent the day shopping at The Pavilion, one of the large malls here. We also saw the new movie, Robin Hood, which was excellent.
Sunday was a beautiful, sunny day. We rode a mini bus taxi to downtown Durban. From there we navigated our way to Victoria Street Market. My mission: to find Zulu baskets! I found a great market shop that had amazing, affordable Zulu baskets. I bought four for myself and one as a gift for my mom's birthday. Here are the baskets Molly and I bought.


After our market adventure we walked to North Beach where we enjoyed a tasty lunch at Joe Cool's overlooking the beach. Then we lounged on the beach for the afternoon. The rest of our evening we spent having dinner with our family.

Pediatrics

On Monday I began my week at King Edward Hospital. This is a tertiary hospital in Durban that serves the entire province. It is a teaching hospital affiliated with the Nelson Mandela Medical School through Kwa-Zulu Natal University. I spent the first three days in the Pediatric Resuscitation Unit (PRU). This is where the severely sick patients receive extra attention and full work-ups until they are stable enough to go to a ward for care. Dr. Ramji was the consulting physician in PRU. He was an excellent teacher and Molly and I joined him on rounds for about three hours each morning. He was detailed, thorough, and compassionate with each patient. We saw patients afflicted by cardiac defects, HIV related complications, Gastro Enteritis, Measles, Chronic Nephritis, Epilepsy, and much more.
Two patients stand out for me. A 3-yr old boy came in who appeared to be under a year old in development. He had Marasmus due to severe malnutrition, HIV complications, and dehydration. This child needed help desperately. It was very difficult to see a child in this state. The children here are products of their environments: extreme poverty, uneducated parents, and other socio-economic factors. Another patient was a 10 year old girl suffering from stage 4 HIV infection (AIDS) complicated by cryptococcal meningitis and marasmus. Her mother carried her in wearing her hot pink sweat outfit and she was adorable and talkative with us. We checked in on her throughout the week to see how she was doing.
On Thursday we went to the nursery and mother/baby units. Babies were everywhere! They deliver about 30-40 babies a day at King Edward. They have an ICU with only three ventilators for the entire province. They also have high care, premature care, and another room for low birth weight babies with complications. I saw about 50-60 babies in the nursery. Some interesting cases I saw: melanoma, polydactyly, myconium aspiration, umbilical central line insertion, and countless lumbar punctures and blood draws. I also so a baby die because its chances of survival on ventilation were less than the three others already on ventilation. It was unbelievable to see how many babies were being cared for in these units and with so little resources. The physicians working in this environment are incredible.

Late Pictures from G.F. Jooste Hospital

The Trauma entrance at G.F. Jooste Hospital:



TB Prevention in all three languages:

Xhosa


Afrikaans


English


Theater scrubs!


Molly and I at the hospital staff entrance:


Last meeting with Marion and Avril

Ushaka Marine World

Molly and I picked up some flowers at the mall on Mother's Day for Zodwa, our substitute mom for the day. She loved the flowers! Then, Molly and I got a ride from Zodwa to Ushaka Marine World. Makabongwe or "Maka B" the 13-year old son at our home stay came with us. Ushaka has 16 water slides, a floating river, and a public beach nearby (equipped with shark nets). We all enjoyed the water slides and river float.



We grabbed some lunch and ice cream before heading to the beach. It was a perfect day to sun tan. Molly and I are determined to look like we actually went to Africa when we get back! The ocean water was warm and perfect for body surfing. Here is a view of the new world cup stadium and downtown Durban from the beach.


At the end of our day we decided to get home "African style." Maka B, Molly, and I hopped in a mini bus taxi and rode to Workshop in downtown Durban. The trip cost each of us only 50 cents. Next we caught another mini bus taxi from Workshop, the central Durban transport spot. We were dropped off right on our street back in Woodlands for about a dollar each! It was the cheapest, fastest taxi ride I've ever taken. One relaxing, fun weekend under our belt and three weeks in Durban to go!

Umlazi

On Saturday, our program group went on a tour of the second largest township in South Africa: Umlazi. This township is divided into districts A-Z and they have even progressed to districts AA, BB, and CC. The township covers an astounding area. Most homes do not have access to water. Every morning people form a que at the water pump and fill up a bucket of water for the day. Electricity and indoor plumbing are scarce. A shack serves as a toilet for a large area. Many people use this one shack as a toilet and place to bathe. We went inside one home that had extremely unsafe access to electricity, unhygienic kitchen and living quarters, and scarce amenities. The districts each have a council with appointed community leaders that keep the community safe. Some of these councils are so strong that crime is virtually erased from their district. They have been able to accomplish this by using "kangaroo courts" that dole out disturbingly harsh punishments for criminals. We also visited a small sanctuary in the midst of poverty. How Long? Park is a park built by hand over the last 30 years by a young man who had a dream to create a place free from suffering in that area. His question inspired the name of the park as he asked the question, "How long will we suffer?"



He and his wife started shaping the park and lived in a two-person shack. Through their hard work they have created an exceptional park and a great home of their own.

Chatsworth Hospice

I spent Thursday and Friday at Chatsworth Hospice. Chatsworth is a predominantly Indian area of Durban. Hospices in South Africa are individual non-profit organizations generating funds through philanthropy and fundraising at the community level. Chatsworth has ten beds available for hospice care. Their hospice system differs from the United States. They care for individuals in the community with cancer and track their progress. They follow up on these patients by doing home visits. Some patients they see weekly and others they see less frequently if they are healthy and in remission. These home visits allow them to assess whether that person should come to hospice if they are terminally ill or whether a few days in hospice may improve their pain management so that they can return home. Otherwise the visits are encouraging to patients undergoing chemotherapy and radiation therapy. Many patients in their culture prefer to die at home with the comfort of family care during that difficult time. Hospice provides the opportunity for families to learn how to care for the person during this time and they can help manage their pain better at home. Other patients can choose to stay at hospice and receive the palliation care they require. Chatsworth staff was very compassionate and loving. It is essentially a home away from home for cancer patients. We spent all day Thursday doing home visits. I saw a range of stages of cancer. The first man we visited was terminally ill from prostate cancer. He refused to come in to hospice and was choosing to die at home. His support system was excellent and he was receiving wonderful care from his family. We were there to check on the family to see how they were holding up and whether the man was doing alright. Each visit included a series of questions, blood pressure measurement, and speaking with the patient a while. A lot of love and concern went in to each visit. We saw about a dozen patients that day. On Friday we sat with the three patients receiving care at Chatsworth. Molly and I talked with each patient for a while, asked questions, laughed with some of them, and listened to their story. The rest of the day we went on home visits. Chatsworth was a great experience. They have done a wonderful job of providing such personalized care to their community.

Marianhill Medical Clinic

The Islamic Medical Association funds Marianhill Medical Clinic. Because it is a private clinic, patients must pay 40 Rand to be seen. There are 2 "sisters" or nurses that see patients. The other staff members organize patients, take observations (BP, weight, blood sugar), and explain how to take medications. I spent most of my time with Sister Karema over the past two days at this clinic. Between her and the other sister they see anywhere from 140-160 patients a day. The most common cases I saw were shingles, STI's (Sexually Trasmitted Infections), Flu, Sores, and a host of other common problems. There were many children seen at the clinic with flu, sores (poor hygiene related), and diarrhea. They have a Voluntary Counseling and Testing center in the clinic. The VCT counselor's name is Vusi. His job is to do pre-testing counseling, HIV counseling, and post-test counseling. He educates those who discover their status on how to go about staying negative or what to do next if they are positive. It's a difficult to job to give that kind of news.
Today one of the sisters took us around the rural area to do some home visits. Unemployment is extremely high and many people that are sick do not have enough money for food or transport to get to a hospital or crisis center for help. It was a very sad experience. Later in the day Vusi took us to visit the local Sangoma. A sangoma is a traditional healer in the Zulu culture. The sangoma is always a woman. She showed us the herbs, oils, and "mutis" (mixtures) that she uses to treat those that come to see her. It was a great experience to see where some of patients seek help and what is actually given to them. It is certainly a very ancestral, spiritual sort of practice. If anything, it works to ease the psychological stress of unwellness and harnesses the mind's healing power over the body. Many Zulu religiously believe in the healing power of the Sangoma.



My time at Marianhill was well spent. I learned how clinics operate to efficiently see many patients in such a poverty stricken area ridden with HIV/AIDS. Tomorrow we go to Chartsworth Hospice Center.

Durban

We arrived in Durban on the opening day of the King Shaka International Airport. It is a beautiful, new airport built for the upcoming FIFA World Cup. Durban is much warmer, greener, and more tropical than Cape Town. I'm loving it! Molly and I are staying with Zodwa and her two sons, 17 year old Qniso and 13 year old Makabe. They are both very nice young boys. Also joining our host family is Toffi, a lively Doxen-Bush mix dog. She is a sweet dog to have around. Molly and I relaxed yesterday and went shopping for groceries with Zodwa. Maureen, the program coordinator, stopped by to give us our phones. Today, we slept in, went for a run, and read for a while. When Zodwa came home from church she took us to "The Pavilion." We are at this HUGE four story mall at an internet cafe. The place is amazing and far nicer than the malls at home. I was shocked! Later today we have orientation with the two students that arrived. They both live at host families a couple blocks away. I am not sure how often I will have internet access so bare with me on the timing of my posts!

Accepted

I am thrilled to announce that I have been accepted to Oregon Health & Sciences University! I will be starting medical school in August. Thank you to everyone who has supported me along the way. I received the e-mail early this morning and it was a wonderful way to spend my last day in Cape Town. Today I was back in surgery. I observed a complete medial malleolus fracture debridement and vac dressing application. I also observed an above the knee amputation, calcaneous debridement, and scrotal abcess. Tonight Ryan, Molly, and I plan to celebrate the end of our time here in Cape Town and my acceptance! Tomorrow Molly and I head to Durban for a new four week rotation through the program. I will update you all as soon as I have internet access again.

T.O.P Day 2

MATURE READERS ONLY

These are my observations of the health care provided minus the graphic details. I have put all politics and beliefs aside:

I arrived in the T.O.P clinic at about 8:30 this morning. Procedures began at 9 AM. The women scheduled to have terminations arrived at 7 AM and were given another dose of cytotec internally. Each are instructed to bring a towel to wrap around themselves as well as a plastic bag to catch anything that may come out before the procedure. They begin with the earliest gestations and progress to the latest. The registered nurses are allowed to perform the first trimester terminations without physician supervision. I watched 18 first trimester terminations which were finished around 11:30. I was the designated hand holder for many of the women, especially the younger ones. These women are not given any anesthetic. The reasoning behind this is that the procedure is quick and the injection is equally painful. Thus, they choose to forgo the pain relief. The nurses are rather unsympathetic to those in pain and conduct the procedures in an unemotional manner. There are only 3 physicians (all female) in Cape Town that perform 2nd trimester terminations. The doctor arrived and got set up for these ones. There were 17 second trimester terminations performed today. They are only given a local anesthetic around the cervix for pain relief. About half the women abort the fetus before entering the procedure room. Those that have not delivered are finished in the room. It is crucial to remove all products to avoid infection. Thus, the physician expels all contents carefully and makes sure that all the parts are accounted for. I apologize for the delicate nature of this topic, but I felt that it was important to share. These women are extremely grateful for the medical care they are provided. Many social as well as economic factors come into play in these communities and it is certainly an extremely complicated issue.
--

Freedom Day

Tuesday was Freedom Day, a public holiday in South Africa. We had the day off from work so Molly and I decided to venture out to Arra Vineyards owned by Neil and Monica. MOnica was a teacher from Nigeria when I was in school there. She is now married and owns a vineyard with her husband, Neil. We intruded on their quiet morning with their daughter Zara to say hello and check out their place. What a beautiful location they had! Neil let me taste a few wines and showed us around their cellar. It was great to see Monica and her family again after almost 10 years!
We had to get the rental car back early so that Jay could get to the airport. He left the program early to go home and graduate from Temple University Medical School. When Ryan got back from dropping him off we all went to the waterfront. Ryan needed to fit in some last minute shopping and then we headed back to Athlone.
Our driver to and from the hospital is "Uncle." He recommended that we try the "Great Gatsby" at the Golden Dish a local favorite restaurant. So, Ryan, Molly, and I conquered the task of finishing equal portions of this massive sandwich. It starts with a 2 foot long loaf of bread. Fries, peri-peri chicken, sauce, lettuce, eggs, and cheese are then piled on. I have attached a picture for effect. We finished this unbelievably huge and tasty delight. I would definitely recommend the Great Gatsby to anyone that ever makes it to South Africa!

T.O.P. Clinic: Day 1

MATURE READERS ONLY

Today marked my first day in the termination of pregnancy clinic or "T.O.P. clinic." The women are gathered in a waiting room at 8 AM. A "sister" (what they call all the nurses here) then briefs them on what they will be doing today. First step is each woman comes in to the consultation room to have HIV testing done. I performed all 35 of the HIV tests on the women ranging in age from 15-43. The HIV test involves a quick finger prick similar to those used for blood sugar testing for individuals with diabetes. The blood droplet is placed on a testing strip and buffer is applied. It takes about 10 minutes to get results. Thus, the women are filed through quickly until everyone is tested. Then they are called back in to be given their results. If someone tests positive a confirmatory test is done that is more sensitive then the first. In addition, they have their blood drawn in order to get their CD4 count. I also performed three blood draws and confirmatory tests for the three women who found out that they were HIV positive today. It was exciting but also disturbing to see how excited some women were to hear their HIV negative status. The reason I say this is because firstly that it is relieving to discover that you are safe, especially in an environment with a 60% HIV infection rate. However, it was disturbing at the same time because these women had no idea whether they were negative or positive because they weren't taking the necessary precautions to protect themselves from such a devastating disease. I will speak about this more when I touch on the counseling sessions.
After every woman is told her status, the physician performs ultrasounds at rapid speed. I have never seen something as efficient as the system they have in place at G.F. Jooste. The physician arrives at 10 am and is gone by 10:30 am, having performed about 35 ultrasounds. The ultrasounds are done in order to find out the gestational age of each fetus or embryo. A bi-parietal diameter (transverse skull) measurement is taken for fetuses over 14 weeks, a crown-rump length measurement is taken for fetuses between 8-13 weeks, and a sac measurement for anything less. They only perform terminations up to 20 weeks. Therefore if the gestational age is found to be 19 weeks then the woman can still have the termination done on Thursday that week.
Each woman is invited back into the consultation room one at a time. A brief patient history is taken and they are counseled on contraceptive use. Most of the women were not using condoms or taking contraceptives of any sort. This is unfortunate because they are not protecting themselves from pregnancy, HIV, or STI's. The sister counseling each woman was terse and adamant about condom use. This is the one thing they drill at each counseling session. I took down a big box of condoms and put it in front of each patient. I was hoping to encourage them to take a pack with them in the privacy of the office. Condoms are free virtually everywhere here, yet a stigma still exists and people are embarrassed to take them in public. Quite a few woman, I believe, felt more comfortable taking some with them in the privacy of the consultation.
The terminations are divided into first trimester and second trimester. The woman are then given an appointment date on Wednesday, Thursday, or Friday that week according to their category. The second trimester individuals are given Cytotec. Cytotec is a drug that causes the cervix to dilate in preparation for the abortion. They take 2 tablets every three hours beginning at 3 am of the day they come in.
Overall, it was a very interesting first day in the clinic. I learned a great deal about gestation, ultrasounds, and counseling methods that are effective in this community. Tomorrow is a public holiday in South Africa so I will be back in the clinic on Wednesday. Although this is a sensitive subject I am approaching it from a purely medical point of view. These women need quality medical care and that is what is being provided at this clinic. I am certain the next three days will be an eye-opening experience.

Paths, Penguins, and Points

We set off on our Cape Point tour on Saturday morning. We drove southeast toward Kalk Bay. Coffee was needed, so we stopped for a light breakfast and coffee at a small bakery looking out at the ocean. Feeling rejuvenated we continued along the eastern coastline of the cape to Fish Hoek. We stopped here to check out the recommended beach path known as the Jager Walk. The path looped around the bay which looks reminiscent of a fish hook. The picture above is from that walk. We certainly lucked out with superb weather for the day. After our walk we drove further south to Simon's Town. Here we explored the ocean side shops, took a walk up higher to check out the view, and checked out this quaint navy town. Up next was Boulders Beach just down the road.

Boulders Beach is habitat to a massive Jackass penguin colony. This time of year is the mating/moulting season. Many of the penguins were in hollowed out sand holes in the surrounding vegetation preparing to lay eggs or mate. We were able to find quite a few down on the boulders and get within a foot of these adorable creatures. The picture above was certainly my best photo sitting next to this friendly penguin. We ate at a restaurant at the boulders. Molly and I both enjoyed the fresh fish and chips. Bridget, Molly's friend from Tacoma who went to the aquarium earlier in our trip joined us for the rest of the day. After visiting the penguins we drove all the way to Cape Point. This national park has quite a few baboons living there. We saw big males, females, and babies. They were cute,lazy baboons, but also bared their enormous fangs whenever they yawned. I certainly wouldn't want to make one of them angry! Below is a picture of the southern tip of Cape Point.





The next two pictures above feature the lighthouse at the top of Cape Point. We walked up there to take in the panoramic view. The beaches below were pure white sand untouched by mankind. It was awesome. I enjoyed exploring the paths at the point. We continued up the western side of the cape until we reached Noerdhoek. From there we went on a windy, skinny road along the cliffs of the coastline. Amazing views of the Atlantic Ocean stretched forever until we reached Chapman's Peak. We all stopped there to watch the sunset with Hout Bay in the background. It was one of the best sunsets I have ever seen. This road was actually shut down for about two years to conduct repair and install rock fall prevention nets. We were lucky to be able to drive it! We stopped in Camp's Bay on the way back to Cape Town to have a quick dinner. We got home early so that the boys could get to bed. They went shark diving on Sunday and got picked up very early. Molly and I had Sunday to ourselves. Molly and I drove down toward Noerdhoek early Saturday morning. We stopped at McDonald's to test out the South African McDonald's breakfast menu. I am pretty sure there was legitimately authentic cheddar cheese on my breakfast mcmuffin! It was definitely better then the super greasy version at home. We wanted to do the Chapman's Peak and Hout Bay drive again during the day and it was just as spectacular. We eventually got to Camp's Bay where we had planned to spend our afternoon as beach bums and avid readers. We spent a good three hours baking in the sun. There were some professional volleyball players at the beach setting up nets. I walked over to the girls and asked if I could join in one game if one of them needed a break. I teamed up with a girl and played one match with them. It was great fun to play a little beach volleyball. One difficulty about this trip has been exercising. It is unsafe to run just about anywhere where we live, thus my exercise regimen has consisted of a few crunches and push-ups, walking down the hospital halls briskly, and throwing in a few lunges. Not much! I have realized how much I appreciate so many of the small things we take as normal back home.

Moyo!

On Friday we drove out to the Paarl region of the winelands. After some serious difficulties with directions, we found Fairview. Fairview is both a winery and cheese producer. Jay, Ryan, and I sampled six wines and a variety of tasty cheeses which Molly joined in on. We each bought a few excellently priced wines to take home. Molly picked out some cheeses and bread for us to snack on in the car together. The photo above explains Fairview's wine label: Goats Do Roam. They have two big goats at the entrance to the winery and the spiral castle is their special home. Quite a few of their cheeses are made from goat's milk. We then spent about 2.5 hours searching for two wineries, both of which we were unable to find. Exhausted and frustrated we decided to go straight to Spier Wine Estate. We had planned to go to Moyo, an African inspired restaurant there. Moyo was a fabulous choice that made up for our difficult day. The restaurant had an expansive layout with some tables in tree houses, others under tents or trees, and the main tent where we ate was beneath a massive canopy tent. I enjoyed a variety of delectable foods from the massive buffet. In addition, in the Xhosa culture white dots are used to create decorative patterns on the face to celebrate occasions. Molly and I both had this done as you can see in the picture above at dinner. It was a unique dining experience.

The Theater

Tuesday marked my first day in the theater. I began my morning by going through ward rounds with the surgeons. I was shocked to see a 15 year old boy who had survived a stab wound through the heart. Stab wounds are extremely common. The surgeons and trauma team here at GF Jooste have an unbeleivable survival rate. They are experts at saving those afflicted by stab wounds. I also saw an older man who initially had a mildly infected hair follicle which spread laterally until the infection covered his entire occipital region over 2 weeks. The solution to a carbuncle like the one this man developed is debridement of the area until the tissue bleeds and healthy tissue remains. The patient lost a tremendous chunk of tissue from the back of his head. The dressings are changed and the skin heals from the bottom up. I also saw a man who was in a car accident and suffered a superficial anterior tibia wound. It became infected and the area had to be removed. He was in for a skin graft to cover the area. He has been healing nicely over the last few days. These are just a few of the cases I saw on ward rounds. In surgery I saw a woman with a left ovarian ruptured abcess brought on by pelvic inflammatory disease that had been present for far too long.
A common theme among the cases they see here is that most patients wait very long to be seen. Their conditions have progressed much further then they should and the solution is surgery. For example, on Wednesday a diabetic man presented with a wet, gangrenous foot. He was going in for a below knee amputation. He has peripheral vascular disease and he had already lost his left foot. In patients with uncontrolled diabetes amputation is often inevitable. In surgery I got to watch a spinal block. Sometimes spinal blocks can be tricky if the ligamentum flavum (the ligament connecting the spinous processes) is calcified. This man had calcification which required some force to drive the needle into the subarachnoid space. The result after anesthetic is administered into the area is that the patient cannot feel anything below the waist. I saw another spinal block done on a young girl about my age who had a complete distal fibular fracture. It was quite a cool surgery to watch. I could see the bone and watched the orthopedic surgeon place a plate along the bone and screw it in place. Wednesday was a good surgery day!
Today I went on ward rounds. An older man was struggling with the decision on whether to agree to a below knee amputation. He fears the stigma of being crippled and chose to wait and discuss the matter with his family. His right foot was gangrenous and would either continue to rot upwards or require amputation down the road. He too had peripheral vascular disease. It's hard to see patients put off making decisions that would greatly improve their health, but in the end it is their choice to make. In surgery I watched a colostomy creation. This a re-routing of the colon so that a hole is made in the abdominal wall and the colon is attached to the opening. A bag is then attached and the individual will pass fecal matter through the opening. This lady had a malignant obstruction which prevented normal bowel movement. Surgery has been exciting and I have had the opportunity to see anatomy in action!

Tik Video Link

For those of you interested in learning more about "Tik" abuse watch this video. It is a documentary on tik abuse in Manenberg where GF Jooste Hospital is located.

Monday Monday

This morning began slowly during my last day in See & Treat. Whenever it rains hard here, patients have more difficulty getting to the clinic due to transportation challenges. I was supposed to be in Infectious Diseases this week. It was very slow today so they suggested I go back to See & Treat. I saw some interesting cases there. A did an ECG on a man with cardiomegaly and a history of TB. A woman with severe lower back and leg pain came in an the x-ray suggested a compression of the sciatic nerve between L4 and L5. The orthopedic physician suggested she needed an MRI to confirm. However, it is difficult to get an MRI here as the patient must see the orthopedic physician before being referred. Thus, the general practitioner schedules another appointment the next week with the orthopod who then refers the patient for an MRI at the tertiary hospital and so forth. Essentially, there is a lot of waiting involved. I also saw a patient presenting with a gangrenous foot concentrated on the 2nd and 3rd phalanges. It had been developing for 6 months! The interesting thing here in South Africa is that many patients are so used to pain, poverty, and unwellness that they tend to let things persist and develop far too long. When they finally see a physician it is often too late to help the person substantially. It is frustrating to observe but I'm learning about how patients think and what prevents people from seeking help even when they have access free healthcare. Toward the end of the day a woman with a posterior stab wound came in to trauma. I went to watch as they performed a thoracotomy. They were attempting to massage the heart, repair the injuries, infuse blood, etc but the trauma was too great. They were unable to save the patient's life. Stab wounds are very common in this area due to high use and presence of TIK, crystal meth. People will steal, kill, and squabble over anything because they are so addicted. Violence persists in the Manenberg area where GF Jooste is situated. The rest of the week I will be in Surgery or "Theater" as they call it here. More medical stories to come...

Garden Route Sunday

On Sunday morning we drove west to Botlierskop Game Reserve. We hopped onto a big safari rig with some other visitors and started our game drive. We saw elephants, rhinos, giraffes, impalas, black impalas, lions, waterbuck, and wildebeast. The giraffes were easily my favorite. The game drive was slow and bumpy on natural roads but our guide got us up close and personal to each siting. We enjoyed a great lunch and set off on the 4 hour drive back to Cape Town. It was nice to be back at the home stay after such an action packed weekend. The Garden Route was a superb trip and I am so glad I got to enjoy it and get to know the group so well. We had many laughs and bonded with Avril and Marion.