Garden Route Saturday

On Saturday morning we drove close to Port Elizabeth, the farthest eastern point of our trip. Here we got ready to do the Tsatsikamma Canopy Zipline tour. We had a crazy zipline leader Siya who joked with us the entire tour, taught us Xhosa phrases, and served as our personal photographer. There were 10 ziplines of various lengths and heights throughout the rainforest. The highest was about 30m and the farthest about 65m. You could seriously pick up speed on the zipline and enjoy looking around the rainforest on the long ones. I had a blast going from line to line. It was also a great warm up for the bungy jump later on. We grabbed box lunches to go and headed for Bloukrans Bridge around 1 pm. See my previous post for the bungy jump experience with pictures! After the bungy jump we continued on to Knysa Elephant Park. The park has saved about 12 elephants of various ages (including three baby/young elephants). We had the opportunity to feed them fruits. Their trunks were muddy and greedy as they cleaned out the food quickly. After feeding we broke into small groups and walked around with a guide. We could walk right up to the elephants, touch their ears, pet them, and look at their giant mouth molars. It was amazing! They were gentle creatures and seemed to love the attention and especially the food. After this awesome excursion we drove to Knysa lagoon where we took a cruise out to the entrance to the Indian ocean. We snacked on appetizers and enjoyed some drinks. I included a picture of myself with Avril, our medical director (right) and Marion , the program coordinator (left) on the cruise deck. For dinner we ate at Checkers, a pizzeria. Molly and I shared a delicious pizza and I had a great South African wine with my meal. Another tasty treat we have discovered are Don Pedros: ice cream blended with some Amarula, yummy! We drove back to the hotel after dinner and called it a night.

Garden Route Friday

We left Athlone at 5 am in our stylish bright blue VW van. Two medical students joined us who were on clinical rotation with Stellenbosch University. Shaziya from Germany and Inge from the Netherlands came along. We stopped for coffee and then ate breakfast at The Country Pumpkin about 3 hours into the drive. Continuing east another hour we arrived at the Cango Caves in Oudtshoorn. We started the Adventure Tour entering the first massive chamber containing massive dripstone formations as shown in the picture above. We went on to the second chamber to see more stalactites, columns, and dripstone formations. The adventurous part was maneuvering through tight spaces in a giant loop. We squeezed through the tunnel of love, up the devil's chimney, and shimmied out the letterbox. Jay and Ryan found the experience to be claustrophobic while us girls had a blast. It did feel great to emerge and escape from the humidity of the caves. We continued on to Cango Ostrich Farm. We interacted with Betsy, the friendly ostrich. I got to feed her and she gave me a hug with her flexible neck. Next we rode ostriches, yes rode them... Needless to say it was a bizarre experience to ride such a massive bird around! We ended our day in the town of Wildernis and checked into our hotel. Molly and I were so excited to find two large beds in our room. It was wonderful to sleep in a big, comfy bed compared to our little twin beds at the home stay. That night we ate at Blue Olive where a live band played as we enjoyed a great meal.

Bungy Jump Pictures

Here are pictures from the Bloukrans Bridge Bungy Jump I did on Saturday afternoon. Jay, Ryan, and I were willing participants while Molly did the zip line under the bridge instead. It was a thrilling as well as scary experience! This was just one of the many activities on the Garden Route Trip I went on over the weekend. Enjoy!

Week Two

I have spent the last three days continuing to observe in the See & Treat and Casualty departments. A new physician in See & Treat has educated Molly and I a great deal about the process of diagnosis, what steps he takes to narrow down possibilities, and plenty of other useful tips. I got to observe the infectious disease ward rounds on Tuesday afternoon. An infectious disease consultant from the big tertiary hospital Groote Schur came to analyze the particularly challenging cases. Some individuals have HIV, TB, and other drug interaction complications. It is difficult to treat such complex cases, therefore it has been an informative experience for me to learn how they deal with these patients complications. Essentially TB treatment medications often have uncomfortable side effects or drug interactions with anti-retro virals. In the case where patients are responsible for taking their medications they often become non-compliant and stop taking some of their meds because the side effects are so difficult to live with. It often creates a vicious cycle of dealing with both diseases. I also observed a few femoral artery blood draws, did an ear examination, saw quite a few Deep Vein Thromboses, and a variety of other cases. A slightly disturbing situation occurred on Wednesday morning. During rounds in Casualty the doctors go around to each patient and briefly discuss their case so that the doctors for the new day know what has gone on over night. Some patients are passed over because their new or are being discharged for example. We passed by a middle-aged man on a wheelchair who looked asleep. About 5 minutes later one of the nurses quickly called over one of the doctors. The man had passed away in the wheelchair. It was an unfortunate circumstance because he had imminent liver failure from hyperglycemia related complications but he should've had a bed. This is a great example of the kind of patient load they are dealing with in their casualty department, the volume of patients is overwhelming and often there are simply not enough beds. I am learning a lot about the many healthcare challenges faced here in South Africa. This weekend we are going on the Garden Route trip with Avril and Marion our coordinators. It should be great fun and plenty of pictures will be up on Monday.

Table Mountain

We got to Table Mountain and starting hiking around 8:30 AM on Sunday morning. We chose the "easy" route known as Platteklip Gorge. It is about a 2.5 hour hike to the top. It was a beautiful sunny day with only a light breeze. It was a gorgeous hike with striking views all the way to the top. Essentially it was like walking on a stair master for two and half hours! I have included a few pictures of our ascent. At the top we explored the mountain top with its panoramic views. We ate lunch and got some sustenance from the cafe. After taking a few dozen photos we headed back down on the steep cable car. We went to Camp's Bay to lounge on the beach. Molly and I braved the frigid waters of the Atlantic Ocean as well. We went to Col Cacchio pizzeria for dinner and indulged in some delicious pizza and malva pudding. We were all tired out from the long hike! That night Molly, our host family, and I watched The Proposal before going to bed. Today, Monday, I spent my last day in See and Treat. A new doctor was here today and he was very helpful with breaking down some of his diagnostic approaches. I also chatted with him about medical school in South Africa versus America. I saw a few patients with him and he explained a lot to me. I also sat in on some patients with Molly. We did an ECG on a patient together and each of us learned how to do our first blood draw with assistance. I also saw a young lady with a grapefruit sized abcess located on the lateral right knee. The variety these general practitioners see amazes me everyday. It has been wonderful to gain exposure to so many issues and conditions. Overall, I learned a lot today!

Perfect Weather Weekend

I don't know if I have introduced you to the other students on our program yet...Ryan, Jay, and Erin are all 4th year medical students graduating as soon as they return to the States and entering residency programs. Erin has been here for three weeks already and this was her last weekend here in Cape Town. She wanted to go to Robben Island and climb Table Mountain. Both of these activities were weather permitting. We lucked out with spectacular weather. On Friday night we got our Ford Tracer rental car which took about 7 tries to get it started each time we got in the car and would have easily qualified as a clunker in the states. We went to Long Street where there are some great restaurants. We ate at Addis in Cape, an unbelievable Ethiopian restaurant. The pictures above show the traditional eating style and coffee ceremony we enjoyed. We also went across the street to watch and partake in some belly dancing at Mesopotamia. Early Saturday morning we drove to the waterfront to be the first in line to get "walk on" tickets for the ferry to Robben Island. We were lucky enough to get on board the 9 am ferry. Once on the island, we were loaded on to tour buses that took us around to the important locations on the island including the prisons, leprosy cemetary (lepers were concentrated on the island long ago), the lime stone quarry where ex-political prisoners labored, and the maximum security prison where Nelson Mandela spent 18 years of his sentence as an ex-political prisoner. I have included a picture of the cell he occupied above. When we returned to the waterfront in the afternoon we had lunch at a South African inspired restaurant called Karibu, the food was amazing. Then we explored the shops in the area since Jay and Ryan hadn't been there yet. Later we drove to Camp's Bay to eat dinner and watch the sunset. We had some tapas and sushi. It was a busy day!

Casualty and See & Treat

My first three days at GF Jooste District Hospital have been a thrill. It has been an eye-opening educational experience thus far. Casualty is what we would call the ER back home. They have many many beds in a large open room with simple curtain sheets to draw around for privacy when needed. There are other students from the University of Cape Town in their 4th year of medical school getting practice. In addition, there is a full staff of nurses, doctors, and support staff. I have been following rounds in the mornings and then seeking out interesting patients and events throughout the day. They see a high load of "medical" patients during the day. This means they see an array of issues from HIV/TB complications, high blood pressure, DVT's, abcesses, stroke, TB, MDR-TB, and meningitis to name just a few. I got to observe two lumbar punctures (taking a sample of cerebrospinal fluid), blood draws, IV inserts, and many other small procedures. It has been most interesting to listen to the doctors line of inquiry and history taking with patients. I feel like I have learned so much in just a few days about how physicians go about reaching a diagnosis or a plan of attack to rule out possibilities. I also spent a great deal of time in the See & Treat section shadowing Dr. Isaacs a general practitioner. She sees patients on referral from the local day hospital. She will take a brief history and look at prior tests if it is their second time back. They see a great variety of issues in this section of hospital. I have really enjoyed learning from her over the past few days. Many things are drastically different here but the process of making a good diagnosis and treating patients effectively is quite similar. The kinds of complications are highly related to the poor sanitation, cramped living situations, and high rates of HIV/AIDS and TB in this region. The number of patients I have seen with TB and HIV is overwhelming. I didn't quite expect such a high percentage. I will be spending some more time in Casualty next week. Hopefully I will be able to post another blog on Monday about my weekend for all of you readers!

District 6/Township Tour

Yesterday we went to the University of Cape Town to get registered and get our ID badges. The university is beautiful, and covered in ivy. Other areas are more modern too. The student population is so different from home though, much more diverse. Next we met up with Colleen. Colleen was our vibrant, knowledgeable tour guide for the day. We would stop frequently so that she could explain the history and progression of South Africa for us throughout downtown Cape Town where that history started. We made our way throughout the city and eventually went to District 6. District Six is the site where people were forcefully removed by the apartheid regime. They were forced to relocate to the Cape Flats with hardly anything in an area comprised of sand dunes. Colleen and her family were from District Six and were relocated to Mitchell's Plain. Other townships include Langa (the oldest remaining township) and the massive Kyalitsha and Guguletu. It is impossible to describe what these places are like. The creatively pieced together shacks of scrap metal and other findings stretch form kilometers and kilometers. Everywhere you look are dangerously tapped electrical wires just to suck some energy from light poles. We ventured through all of these areas as Colleen described how they came to be and what they are like know. They look dirty and disorganized, yet there is great control and organization within them. Some of the major issues are HIV/AIDS, TIK or crystal meth use in youth, early sexual activity, and gang violence. Many organizations are there to help from grassroots efforts including Love Life funded by the Gates Foundation. Essentially, Tuesday was an overwhelming amount of information both verbally and visually. One uplifting place we visited was Philani Nutrition Center. This is a place where professionals go out and identify malnourished children in Kyalitsha. They then invite the children and their mothers to come stay. The children are fed and educated while the mothers make woven work to sell and earn a living. It's a wonderful place! What an amazing day though. I'll have more to tell about today (Wednesday here).

Let's Play Catch Up

I got internet access today! What a joyous occasion. On Saturday, Avril Whate the medical director here picked up Molly and I and drove us to our host family's home in Athlone. We are staying with George and Irene Snyders. Molly and I share a room with two twin beds covered in floral pink sheets. We settled in and unpacked. The Snyders invited us to spend the day with their extended family. They have two daughters and a son. Their daughter is married to a South African former soccer player who is quite famous and will be working with ESPN on World Cup coverage here. The Snyders have 6 grandson who were running around and playing all day. We went to the Oyster and Champagne Festival out in Durbanville on a vineyard. They had live music, food, drinks, carnival stuff for kids, etc. It was fun to get to know their whole family. We stopped at Fruit & Veg on the way back to grocery shop for dinner and their produce is soooo fresh here! I was in awe by the variety and quality of it. Back at their son's home they daughters and son cooked up this amazing dish call seafood potje. It's made in a three legged iron pot and cooked over hot coals. Needless to say it was a tasty meal accompanied by food, food, and more food.
On Sunday Molly and I ventured over to the mall about 10 minutes from our home stay. It looks very much like a mall at home. When we got home we had Easter lunch with George and Irene. We lounged around the rest of the day.
On Monday we joined the boys Jay who is a 4th year medical student at Temple University and Ryan a 4th year medical student at Michigan State. We attended a briefing session about the healthcare system, do's and don'ts, and other useful information put on by Avril and Marion (local coordinator). Both ladies are wonderful, honest, and have been of great help so far. We met up with Erin, a 4th year medical student at Penn State, who has already been here for 2 weeks and went to the mall together. We all had coffee and got to know each other better. That's enough about those three days!

Two Oceans Aquarium

Molly and I sat in a small cafe drinking coffees, writing postcards, and reading. We then basked in the sun for a while before getting ready to walk down to the waterfront. We met up with Bridget today at the Two Oceans Aquarium. Bridget went to Pacific Lutheran University and came to South Africa for an internship in environmental conservation. She has been here for two years and was a wealth of information. We enjoyed the aquarium. They had tropical fish, jellyfish, sharks, penguins, frogs, and many other animals from this region. We headed to Mama Africa for dinner. This eclectic restaurant was decorated in an array of African art and flare. The restaurant had a live band playing African vibe music with xlyophones, drums, and a powerful lead singer. We had crocodile kebabs with peanut satay. It tasted like chicken! I ordered Mama Africa Chicken Curry and Mavla Pudding for dessert. The dessert was amazing! It was a caramelly buttery pound cake like treat with ice cream. Bridget took us back to our hotel and Molly and I packed up all our stuff. The program starts tomorrow. Our program coordinator Avril is picking us up at 11 to take us to our host family in Athlone. I am so excited for the program to start and to meet my host family. Plenty to share next time!

Petting Cheetahs

Molly and I (fully recovered) set off on the wine route tour. There were three others on the tour: an older lady from Oxford and a "snow bird" couple from Toronto spending a month's holiday in South Africa. We drove out to the winelands to the Paarl region. We bagan the day at the Nelson Creek Vineyard. Olivia gave us an informational run down on the wine making process starting from the vines all the way to the bottle. It was an educational experience! We got to sample 5 of their wine varietals accompanied with some tasty cheeses, crackers, almonds, and dried apricots. I usually dislike dessert wine but they had an unbelievable one that was both sweet and tart to the taste. From there we drove on to Franschoek which means "French Quarter" in Afrikaans. The town was more "up scale" and catered to an expensive crowd. The traditional Dutch architecture with simple structures, shutters, white wash, and thatch rooves was picturesque against the vine covered hills and mountain ranges on all three sides of the small town. We stopped at Rickety Bridge to sample a range of their wines. Pinotage is a signature South African wine and I bought one there. Next we drove into Stellenbosch. The University there is beautiful and it had a college town feel. We had some pizza and iced coffee and wandered through shops around the town. Next stop was the Spier Wine Estate. They have a cheetah outreach center where we got to pet Joseph a 7.5 year old male cheetah. It was amazing! Definitely an experience I won't forget. We headed back to the city and shopped at the Waterfront a little before walking back to our hotel. Molly and I enjoyed a delicious meal at the top of our hotel. The restaurant is a revolving on similar to that at the Space Needle. For dessert we ordered bananas flambee with cinnamon ice cream, so good! Today we are headed to the Aquarium. More news to come!

A Trip to the Hospital

Well, I had the pleasure of taking a trip to Christian Barnard Memorial Hospital last night. I have had a terrible, repetitive cough the past two days. Those of you who know me well have had the pleasure of hearing my seal-like barking cough. Last night I woke up with shooting, sharp pain from my lower back and up through my spine. I was sweating profusely all over. I had to lay down on the bathroom tile and Molly got an ice pack to put on my back until I broke out in shivering and chills all over. We called the program coordinator and she sent Avril, the Nurse Practitioner, to come pick us up. She took Molly and I to the private hospital (which was actually recommended by my insurance back at home). They did a blood test, ECG, and a chest x-ray. I have a lower respiratory tract infection. They gave me a round of antibiotics to take over the next 5 days, some heavy duty cough medicine, and pain meds for the back pain. The shooting back pain turned out to be referred pain from my diaphragm which was worn out from all the coughing and extremely stressed. It was quite an interesting experience to say the least. However, I'm feeling much better today. The meds are kicking into gear and I am on the upside of things. Molly and I figure if this is the worst of our health problems for the trip then we have got it all out of the way, should be smooth sailing the rest of the trip! So, for today we are laying low (again) and recovering so that tomorrow we can go on the wine route tour. Sometimes you just need a doctor to make everything all better :)

R&R

Rest and recovery. Molly and I are quite the pair. Molly came down with a bout of food poisoning/traveller's sickness last night and spent most of the night praying to the toilet god. I on the other hand did not get sick from eating the exact same food. Instead my crazy cough came back and I have some serious sinus congestion and a pounding headache. Just what you all wanted to know! We both laid in bed all day and I was able to go out for sustenance for Molly: applesauce and saltines. We are laying low today and we have rescheduled the wine route tour for Thursday. Don't worry Biehl parents, I'm taking care of Molly and she is feeling better! Hopefully we will be back in action by tomorrow. Hopefully I will have something fun and exciting to talk about then.

City Tour and Green Market Square

We set off on a tour of the city today. Our driver Isi came to Cape Town from the Congo when civil war broke out there. He was a wonderful tour guide and very knowledgable. He took us to all the highlights of Cape Town. We drove to Clifton Beach and Camp's Bay. The mountain ridges on the western side of Table Mountain are called the Twelve Apostles and we took some pictures of them rising up behind the bay. Next we drove up Signal Hill also known as the "Lion's Head." The view from the top was unbelievable. We had a panoramic view of Cape Town, Robben Island (picture above), Table Mountain, and the ocean. Guinea fowl run free at the top and it is illegal to hunt any animals or birds in Cape Town. We stopped in the Malay Quarter on the way down to buy some spices at a shop Isi recommended. I bought some curries and masalas to bring home, yummy! We stopped at Destinee a Diamond and Tanzanite store. We saw a 14 carat Tanzanite stone, it was beautiful. The jewelry there was amazing, if only I had 10,000 dollars to spare! Needless to say it was a pricey place and we were just excited to see some impressive gems. Next we drove down Long Street toward Greenmarket Square and on to the Iziko Museum of South Africa. It was an archaeological, historical museum with a vast collection of artifacts from early history to the present as well as a multitude of wildlife on display. There was a massive Blue Whale skeleton in the center of the museum as you can see in the picture. We also stopped at the Castle of Good Hope and then had Isi drop us off at Greenmarket Square. First on our agenda was lunch. We went to Safari Burger and each order the Ostrich Burger. There are no words to describe that succulent morsel. I ate it with relish and then we hit the market. I bought a plethora of items as gifts and some things for myself including a pair of Springbok skin pillowcases (they aren't endangered and are so soft). We also went in the Pan African Market, a four story enterprise similar to an antique mall. These markets had everything you could possibly imagine from all over Africa. There were shopping temptations left and right but I came out without too much of a dent in my pocket and quite a few bargains in my shopping bag. Tonight we are laying low and getting some good rest before we embark on a Wine Route Tour tomorrow.

JAWS

Yes, I went great white shark cage diving! Molly and I were picked up at 5 am yesterday morning and a group of 8 drove to Gansbaai on the coast. We had a quick breakfast and then jumped aboard a massive Catamaran. The crew took us about an hour out to sea to Dyer Island. This island is home to over 60,000 cape fur seals and cape comrade birds. The smell was overwhelming disgusting...however, once we rounded the island the wind blew the other way, thank goodness. We dropped anchor and the dive master gave us a quick run down on safety rules: keep all limbs in the cage, get in the cage when he says so, get out of the cage when he says so. Pretty simple rules for not getting eaten! Of course Molly and I volunteered to go in the first group of six, we wanted to get into dry wetsuits. We were ready to go, cage was in, and bait was set. Then we waited a very long time. Finally the sound of Shark! (usually terrifying words in most contexts) was heaven to the ears. We quickly got in the cage and waited for the shark to come back up. They were surprisingly shy creatures. One swam right in front of our cage and another was about 10 meters behind us. It was thrilling! The water froze us all half to death and we came out with white knuckles and toes. After warming up we watched the next group go and got a great view of a shark at the surface from atop the catamaran. They are massive and impressive. We boated back to Gansbaai with the sun on our faces, finally warm. The two hour drive home wasn't bad. Molly and I talked to our parents on Skype a bit and then walked to the V&A Waterfront for some more delicious Indian food and ice cream for dessert. Definitely an amazing day!

The Half Marathon Walk

Molly and I got our hiking gear and backpacks to hike up Table Mountain. However in the lobby, the travel guy, Henry, who let us know how to hike it the day before made a call to Table Mountain. The cable car was shut down and no one was allowed to hike today...bummer! The cloud cover and winds were too harsh. So we decided to book a couple tours through the travel office for Monday and Tuesday. Then, we set off for Camps Bay. We stopped at a recommended place called PostNet to grab a world phone card for me to make calls home. Then we pressed on for another 7 miles to Camps Bay. The road ran parallel to the beach so we had some great views on our walk of ocean waves crashing on the rocks and sandy beaches below. It reminded me of Newport or Laguna beach. Instead of a small beach though, the white sand stretched the whole way there. There were fancy condos and homes all along the cliffs and right down to the water's edge. We arrived in Camps Bay and had lunch at Cal Cacchio an Italian pizzeria. The meal was tasty! After rejuvenating and leaving the restaurant we walked along the beach for a bit before heading back to Sea Point where our hotel is situated. After freshening up we hit our favorite Newport Cafe only to encounter further hair-pulling internet frustrations. After an hour of tinkering, we decided to bite the bullet and just pay for internet across the street: problem-solved. Tonight we are just laying low for early dinner and maybe a good movie on TV. We deserve a rest after our half marathon walking tour!

The Malay Quarter

Today Molly and I ventured over to the Malay Quarter of town which has an Indonesian and Malaysian vibe to it. Above is a beautiful yellow Mosque in the neighborhood. It was surrounded by colorful houses in pinks, greens, blues, and yellows with all the young children playing soccer in the street. The hype over World Cup is definitely in the air over here. We stopped at Africa Cafe for some african tapas for lunch. You can see my tasty meal. The rest of the day was spent troubleshooting with our computer and chatting with an American girl at the internet cafe about suggestions for restaurants, how to buy a world phone calling card, and fun things to do in the area. Tomorrow we are planning to hike Table Mountain on a popular weekend trail. More to come!

TIA

This Is Africa
Well I survived the total 25 hours of flight time alone and have landed on the stunning continent of Africa. Molly and I met up in Amsterdam Schipol Airport at our gate. It was so nice to see a familiar face! Our looooong flight consisted of watching 4 complete movies, indulging in some delicious plane meals believe it our not, and arriving at 11 pm in Cape Town. We both got our baggage (yay!) and found an airport authorized shuttle service to get to The Ritz Hotel at Seapoint. Our hotel room is modest but has all the necessary amenities and extremely comfortable beds.
Today we slept in until 9:30 and Marion our program coordinator called to check on us and make sure we arrived safely. Molly and I decided to walk along the beach boardwalk to the Victoria and Alfred Waterfront which is about a 20 minute walk. They have a shopping mall that is reminiscent of Bellevue Square. We looked in many of the shops. Then we found an Indian Restaurant on the waterfront that had a view of Table Mountain and had a yummy lunch. After that we explored all the shopping, watched street performers, and went to look at arts and crafts places. Then we walked back to the hotel and decided to come check out a cafe with free internet across the street. So far so good! Cape Town is wonderful and I am looking forward to the days to come.

Amsterdam

I had a breeze of a flight from San Fransisco to Amsterdam. I spent my time on the 10 hour flight (eek!) watching Up! and The Time Traveler's Wife and then sleeping the rest of the time. Today I went in to Amsterdam to visit the Van Gogh Museum. What an amazing collection of art. Impressionism at its best. Then I sat at a cafe for a late dinner. Amsterdam has such an efficient public transportation system. You can hop on a train right in the airport entrance which takes you to Amsterdam Central Station. From there just jump on the right tram at it will get you to virtually anywhere in the city. I was impressed! I will be taking off for Cape Town tomorrow morning at 10 AM. Molly will be meeting up with me at that point. Smooth travels so far!

Back to Africa

I'm so excited! This picture captures the giddy anticipation I feel about this trip. It happens to be a snapshot from my younger days in Africa. Tomorrow Monday, March 22nd I fly from Seattle to San Francisco. From there I catch a flight to Amsterdam and should be arriving around 11 AM on Tuesday morning. Let the adventure begin!