Destination Seattle Please

I woke up to clouds and grey skies today, so Miles and I decided not to go on the skyrail at the stadium since the view wouldn’t be too clear. But, we still wanted to get out and do a few things. Zola, my host mom, came along with us. We went to the stadium to go to the world cup store again—there were a few things both of us wanted to pick up that we hadn’t the time before. And, since it was cloudy, we weren’t going to go to Ushaka either. But, right behind Ushaka is the beach front, and on the sidewalk between the two, villagers set up all of their crafts, and we wanted a couple more of those too. We looked at everything for quite a while and found some really good things. I’m so excited! I can’t wait to send things home this week. All three of us were kind of hungry at this point, so we went into the Ushaka mall area and had lunch. Zola decided she wanted a shot or a “shooter” as they call it here, so we got pictures of her in action. South Africa has a really interesting pizza that Miles and I have both fallen in love with. They call it a Caribbean or a New Orleans depending on where you go, but it has bacon, banana and avocado on it. At first, we were both quite hesitant about the banana part, but it’s the best thing ever! I can’t believe how tasty and addicting it is. That’s what I got today (: There was a homemade fudge shop here too, so we stopped and got some of that on the way out. It reminded me of my dad (:

Later in the evening, Miles, Boom Boom and I went to Florida Road, back to Cabana, the restaurant/bar that we went to last time we came. We had fun, just relaxed and had a good time.

I leave for Cape Town next Saturday. In one aspect, I can’t believe I have already spent five weeks in Durban and it’s time for me to leave, signifying my trip is half way over. On the other hand when I think about each individual day, it seems like time went by very slowly. But I think time went by quickly more so than slowly as a whole. I’m blown away that it’s already almost May! When I think about having to spend another five weeks away, I wish that I was flying home instead of to Cape Town. Yet I’m also excited for Cape Town! I’ve been told it’s a lot more exciting than Durban and that time goes by so quickly, for one because of how much stuff there is to do, and also because it’s the last leg of the trip. Ah, so many emotions have been simultaneously emerged during my time away from home. I’m trying to convince myself that I will have an amazing time in Cape Town and that time will fly. Hopefully before I know it I will be boarding the plane, destination Seattle.

Clocks and Whitney Houston Hair

Last night I discovered that AED, the pre-medical honor society that I belong to, had given me an HIV/AIDS epidemic evolution DVD that I happened to bring with me to Africa. And, as I looked through the contents, everything that the lecture talked about was the exact information I needed for my thesis. How perfect is that! It’s going to be a fabulous resource, so that’s amazing news for me. Today was really quite uneventful in the office. We didn’t do a whole lot, but we did scrub in for another circumcision today. It was just the same as last time. Funny thing though—after Dr. Khan has done all of the cutting and cauterizing, he sews the skin back together. Did you know that dissolvable stitches are made out of cat gut, by the way? Anyhow….as he goes about the whole procedure, he explains everything very well to us, and makes sure we can see everything that he’s talking about. When he sews the skin back together, he talks to us about the “clock”…can you imagine what he’s talking about? On the bottom side of the penis is a pretty visible line, and he stitches that together first, and that’s called six o’clock lol as we were well informed. Then he stitches the top together, which is twelve o’clock. Then he does nine o’clock, and lastly three o’ clock. Then he stitches the spaces between the four clock marks. I have never heard of somebody comparing surgical procedures to a clock; it was kind of wrong lol.

We picked up our rental car, for the last time in Durban, this afternoon. The car that we were supposed to get was late for some reason, so they upgraded us to a nicer car that was already there for the inconvenience; how nice (: We headed to the Durban Stadium because we found out it has a skyrail! If you look up a picture of this stadium, it has two poles that run from both sides of the ground beside the stadium, to all the way up above the stadium, where they connect. On these pole structures, they have sky trains that can take you all the way to the top to get a lovely view of all of Durban and the Indian Ocean. We wanted to go, but when we arrived, were informed that it was closed down for the rest of the day for maintenance, and that it would be running again in the morning. We will most likely go tomorrow, but if not, sometime this weekend. Tuesday is a holiday, so we have an extra long weekend again. We are going to go on the sky rail, to the beach behind the Casino, to the Gateway mall (the largest mall in South Africa—we didn’t even finish looking through half of it last time), and to a place called Ushaka. Ushaka is this mega water world/aquarium/shark and dolphin diving/shopping mall/beach front/craft boardwalk/restaurant and nightclub hot spot. It’s like everything in one, and it’s humongous. It is the home to the tallest water slide in South Africa, which I will NOT be going on haha. It should be really fun, so sometime this weekend we will spend a whole day there.

I also got in contact with the bishop down here, and since this is the first weekend I am staying in town, he is picking me up for church on Sunday morning. I’m pretty excited; I’ve missed it a lot, plus it will be an adventure to go to church in a different country. And just an “entertain the idea” ‘tidbit’ (auh I hate that word) for the day, I woke up with hair like Whitney Houston. Because of the humidity, my hair curls up really tight, so it look shorter and is more afro-like than in Washington. I usually take a bath before I go to bed here so that my hair can dry during the night and be ready to go in the morning. In Seattle if I took a shower at night I wake up and my hair is still half wet, and the dry parts are hideous and unstyle-able. Here, I wake up to lovely curls that I usually don’t even have to touch; most of the time I just do my makeup because my hair already looks styled. And my curls look so much better here due to the humidity; who would have thought?! I was preparing for the worst, only to be pleasantly surprised by the best. Anyways, today I woke up to hair that was a little bit wilder than usual—very afro like and big. I was going to put some more product in it to get it to lay slightly flatter, but Uncle Roy got here early this morning and I didn’t have time to! So my hair was very Whitney Houston-esk and afro big (: almost like woah daddy. And to top it ALL off, it was windy today, which only made my hair bigger. Miles got a pretty good laugh out of it.

I was wearing my pajama shorts tonight, and Zola walked behind me and patted my butt, and goes “woah, why do you have a booty??” it was pretty funny (:

Road to Recovery FINALLY

I had a question about this, so just in case anyone else didn’t know, I will make it clear now. Miles is the other intern on this trip with me from my university. He is a very cool guy and we get along great, which is good because I have to spend every day of this ten week trip with him. And, he lives with his boyfriend back home, so (: no worries about anything.

All that happened today, surprise surprise, was more paperwork! I learned however that Kwazulu-Natal (this area of South Africa) has a higher HIV infection prevalence than the United States as a whole. Is that not mind blowing? It’s terrible. Almost every one of Dr. Khan’s patients is either HIV positive or has progressed to AIDS. In the United States, I had to search out and find an organization that worked with the HIV infected population, and here, that’s all there is. What a huge difference.

As some of you may know, I got really sick while I was in London, and it lasted with me for about two weeks. Even after those two weeks, I was still feeling sick and had some of the same symptoms to a lesser degree. I thought something was wrong, and was guessing I had an upper respiratory infection. I asked Dr. Khan to check me out since I was already there, and sure enough, he found something! It wasn’t the URI as I thought it was though. I have tonsillitis! I didn’t even think about anything being above my chest area. He noticed a bump by my tonsils in the back of my throat on the right side, and swelling of my lymph nodes on the left side. He guessed that the cold medicine I had been taking while really sick had knocked the left bump and right lymph node swelling away, but didn’t get rid of it completely. He gave me antibiotics to make it clear up, so I’m FINALLY on the road to recovery after five weeks! Yippey. I can’t wait to feel 100% again! There was really crazy wind tonight—the news said it was around 30 miles per hour, and he wasn’t joking. It sounded like it was going to take the house with it! And trees were practically tipping over; I kind of wanted to stand outside just to feel it because it was so crazy! But I thought better—nobody would have ever found me again if I had (: it would have picked me up and blown me all the way through Africa.

Male Vaginal Discharge and Alligator Swamps

Today was just more file searching at the office. Miles and I found something really funny that caught us off guard though; the file was for a 49 year old male, and “vaginal discharge” was listed under his current medical conditions…?!!? We started cracking up…this was clearly a weird mistake. But what condition was really supposed to be here….? Hmmm….

Miles also got an interesting sex talk from Dr. Khan today. I had walked back to our file work, and he followed Dr. Khan into his office, and when he returned, he was kind of traumatized. He told me that Dr. Khan gave him technical instructions on how to have sex. .and he said the funniest part was that Khan referred to it as “dipping in”…auh! Glad I missed that one.

Later that night, Miles and his host brother Boom Boom came over to play a card game with my three host brothers and I. The game was called donkey spoons, and Mini made some pretty harsh consequences for whoever lost the game. It was only fair that he himself lost, right? So, out of the ten consequences, we were really contemplating two, but decided he was getting the “fear factor drink”. All of us headed into the kitchen to cook up a concoction for him to drink, and it was pretty bad. The drink consisted of chili juice, peri-peri hot sauce, mayo, an egg, beets with beet juice, minced garlic, cooked spinach greens, sea salt, water, and to top it all off, a coconut marshmellow. I think that was it—there might have been a few other gross things in there. Anyways, Mini was freaking out saying he was allergic to everything in the drink because he didn’t want to drink it. What a sucker! He could make the consequence up, commit somebody else to it, but couldn’t handle it himself, so we had no mercy. We all headed outside to watch him chug his fear factor drink. He pouted about it for a long time while we all yelled at him to get it over with and get to drinking. Zola even popped her head out of the back door and told Mini to man up and drink it haha. He stuck his tongue into the drink and told us it was disgusting and that he couldn’t do it—wasn’t that the point?!? We continued to convince him to do it, and finally he took a big chug…and then immediately spit it AAALLL out. None of us were happy with that…so we told him he had to drink half of the glass (it was pretty tall) before we were pleased with him completing his consequence. He told us it was way too hot, so we gave in and gave him a milk “chaser” haha. We got him to take another drink, which he immediately spit out as well. He wasn’t too happy. We told him that if he drank a shot glass of the mixture, swallowing it all, then he could be done. He agreed, drank, and spit it all out. So, since he failed at completing that consequence, we all agreed that he then had to complete the other dare we were contemplating earlier (:

My host family has a swimming pool in their backyard, which used to be nice, but the cleaning tube or whatever it is that purifies the water broke about two months ago. It now looks like an alligator swamp. As you can guess, the second dare was to jump into the pool and stay there for three minutes. We were trying to be nice, and instead of making him stay in for three minutes since he at least attempted the other bet, he just needed to just jump in. From the lower back yard, you have to go up stairs to reach the pool. Mini was being really stubborn, so Miles’ host brother Boom Boom had to grab his hand and drag him up there, including up the stair pole…haha! When they finally got him up there, he wouldn’t get into the pool. He was being such a weenie for having created all of these consequences. The boys each grabbed one of his limbs to throw him in, and in an effort to make things easier for mini (aren’t I sweet? :) ) I suggested that they take off his pants and shirt so that he was only in shorts. I would imagine that to be a lot more comfortable when wet in a nasty pond. Mini was still fighting, so they boys took his clothes off in midst air. Once he was down to his drawls (just kidding, shorts) they all tried to lunge him into the pool, but he was a fighter! They struggled to get him in for about five minutes while I stood back and took pictures while cracking up. They finally succeeded, and in he went. He quickly climbed out and tried to shake all of the water off onto us; what a punk. He immediately went in to take a bath, and that I don’t blame him for. The ‘swamp’ is pretty scary. We had so much fun, and laughed like crazy. I took tons of pictures of all of this that I posted on my facebook if you want to see our fun (:

Miles also reminded me of something that we saw while in Margate. All of the villagers set up their crafts and items around the beach to sell, and while walking down, everything surrounds you, so it’s inevitable to see it all. We both had looked down at a certain set, and happened to see rhinestoned “dolche and cabana” sunglasses, and died laughing. We wanted to take a picture, but didn’t want to offend the woman, or make us stick out more as ‘tourists’. I know quite a few people that would have appreciated those though (mamacita :) )

Files Files and More Files

Sawubona, Unjani! (Zulu ‘introduction’ for hello, hope you are well) Today was VERY uninteresting. All we did the whole day was sort through files and gather information for our theses. We created an outline and starting keeping data in an excel chart, which is taking forever to put together. It’s also taking forever to search through each person’s file to determine if their case is relevant to our theses, and if so, find the information we need. We are focusing all of our attention on HIV patients currently on treatment. It’s quite interesting to see how pre-existing conditions are affecting the progression or digression of the disease treatment, and what co morbid infections are being developed, if any. It is also pretty interesting to see how each person is responding to treatment, and what happens when resistance starts, or when adherence and compliance to the patient’s regime falter. This is all we did the entire day. Dr. Khan didn’t have anything interesting going on with his patients, so we didn’t get to mix our day up with a little excitement. It was just pure paperwork. And for some reason, the first half of the morning I became so tired I could barely keep my eyes open, which made the work even more torturous. Tomorrow we are going to collect a bit more date in the morning, and then start actually writing our papers in the afternoon. Hopefully by the end of the week we can have made some solid progress towards finishing our theses. We are hoping it works out this way! My family was having shelves built on the walls in place of their wardrobes that sit against the walls today, so it was really loud. You could barely hear anything over the drills and wood being cut. It was pretty annoying, but luckily they have left for the day, and we are left in peace for the rest of the evening. This whole week is going to be quite slow, so I won’t have much to say. Maybe Dr. Khan will throw something exciting at us to keep us looking up throughout the week.

Dr. Khan's

We are back to work. This week however, instead of working in hospitals or clinics, our medical director Dr. Khan is letting us come to one of his offices to look through patient files to collect data for our theses. This is very helpful, and I’m glad we are getting time set away to do this. But, because we were just looking through files, it was quiet an uneventful day. One thing interesting happened though. Dr. Khan was seeing patients this whole time, while intermittently coming to check on our progress, teach us a few things, and answer our questions. He was about to perform an adult circumcision, and asked if we wanted to scrub in and participate. Since things were pretty dull, and we had never seen one, we figured why not and got ready. We both opted to watch rather than assist this time. It was quite interesting, but I think it would be a smarter idea for a man to get this done when he is first born. Traditional men in South Africa always get circumcised at birth, but in the last few years, this has changed, and has left millions of grown men uncircumcised and more prone to infection and contracting HIV/AIDS. This is clearly a huge issue since HIV is so prevalent in the country, and the government has initiated a plan to have these millions of men circumcised to reduce their chances of contraction from 100 to 10%. Because of this initiation plan, clinics have been swamped with men wanted them done. Dr. Khan is a really good doctor, and made the procedure virtually painless for the patient. He wasn’t asleep however, which I would have personally wanted if it was me. But, this is Africa and that’s not how they do things here. He got a local anesthetic shot into the area around his penis with a needle, which was pretty painful for the patient, but it became numb very quickly, and then it was all fine. The procedure itself didn’t take very long, and then he stitched the skin back together and sent the man on his way. We also got to see an HIV infected man with TB of the auxiliary lymph nodes, which are in your arm pits. I didn’t realize that you could get TB in certain areas. I thought if you had TB, you had the characteristic cough and spray etc, but I was wrong. You can have TB in one area, such as certain lymph nodes, that give you no cough or anything like that. Dr. Khan needed to take a biopsy to see if there was pus in this lymph node. If there was, he needed to cut it open, drain it, and stuff the ear with gauze. But luckily, there was no pus and no incision. He sent the biopsy to the lab for testing, and we finished up some paperwork before leaving for the day.

Princess Spa

Today was spa day!! I was so excited. On this covered outside terrace, our hotel served breakfast to their guests, so before heading down to the spa, we ate. There was tons of food on this table, so we grabbed croissants, cereal, yogurt, fruit, and juice and chose a table. We thought this was breakfast, only to find one of the maids coming our way to ask us how we wanted our food! They made us toast, eggs, bacon, sausage, beans, tomatoes, sweet corn and mince on top of all of the food we already brought to our table! They also brought us coffee and tea, so we were stuffed by the time we were finished. We went and changed into our robes and slippers and headed downstairs to start our spa extravaganza (or should I say mine??) Mine was happening in this incredibly cute hut looking structure that was dark with soothing music playing, one bed in it, and French doors that opened up to the pool and beautiful landscape of the suite and surrounding land. It was amazing! My pampering took four hours and was the most relaxing four hours I have had in a very long time. I felt like such a princess. My masseuse was this cute native lady named Maggie. All of the products they used were made in the Cape area with natural plants and extracts of plants only found in South Africa. They were amazing, and I bought a bunch of them to bring home (: I was so relaxed. Miles finished before me, and was lounging in a chair by the pool. I came and sat by him for a little while, while the maids brought us freshly squeezed juice that was amazing as well. It was the most incredible experience ever. We lazed around for quite a while, and then decided to go eat before we headed back to Durban. On the same water front as Panarotti’s the night before, we found a restaurant called Mugg and Bean, one we have become quite familiar with during our stay here. We parked a ways away so that we could walk along the coast and take pictures, and see all of the crafts the villagers had set up along the same path. We ended up finding and purchasing some more cool crafts, took some amazing pictures, and then went to eat. Mugg and Bean has the most yummy giant muffins, so we of course got some to go (: then we started on our drive home. We were very satisfied with how our weekend panned out, and I was still so relaxed. It was a great day.

Margate (:

Miles and I surprisingly left on time this morning! We drove to Margate, which was only an hour and a bit away. It was in the opposite direction as St. Lucia, so the scenery was completely different. It was absolutely beautiful, and since the drive was really short it was enjoyable. Margate is a stunning town with beautiful beaches. We were so excited to get our stuff checked in so we could get to the beach and swim (it was cooking outside) and hopefully get a cute little tan. We also found the most amazing place to stay, called the Ingwe Guesthouse and Spa. It had a stunning view of the Indian Ocean from our deck, and was a four star bed and breakfast with incredibly hospitable service. Our room was the cutest thing, it was so exciting! We had booked to go to the spa in the morning, which was also really exciting! It was really cheap for us; the exchange rate is definitely in our favor. I was going to get a full body massage with a facial, a manicure, pedicure, and a head massage and hair treatment. Talk about being pampered. While we were getting our stuff put away in our room, one of the maids came by with robes and slippers for us for the morning (the spa was downstairs by the pool). We left and had lunch and a silly place called Mr. Fish and then went to the beach, yayy! We had been waiting so long to do this. It was the most breath taking beach you could ever see. Part of it was the whooshing Indian Ocean, which was beautiful, but the other side of the beach was even more amazing. It had still water on this side, completely surrounded by sand on the beach and then this jungle. It was a huge secluded cliff with all of these trees and plants growing out of it. You could see a view of all of this from a bridge on the road above, and I took tons of pictures! It was so amazing. There were shops on our way to the beach, so we stopped inside. We found this red coconut dark tanning oil, with no ingredient list or anything, but Miles decided to buy it, aaand we used it lol. On the beach, some villagers had created sand art, I think you would call it. They were incredibly good, so I took pictures of this too! Then we parked ourselves by the still water and jungle side of the beach to soak up the sun that I have been loving down here. It was so nice to relax and feel the ocean breeze as we felt the sun at the same time. This is when we noticed something odd. To our right, there was this couple that looked like they ‘lived on the beach’. Miles and I named them the negatives, and I’m sure you will never be able to guess why unless we tell you. Mom absolutely died when we told her about it later that night, and would have never caught on to the true meaning being ‘negative’ unless we informed her. They were so disgustingly dark, that they were the color of people in photo negatives. It was the most horrible thing we have ever seen! Their skin was so damaged that they looked like a huge blob of cancer. When we wanted to go get in the ocean, we needed somebody to watch our bag, and who better than the negatives?? We asked them to watch it, and they quickly agreed. They were from Germany, as we later found out, and had bright blue eyes with white hair, so you can imagine the contrast only made things worse for them. Especially after we knew that they were really supposed to be pale. But, we went on the ocean and it was amazing. It was pretty warm, and the waves were fun. They were very powerful, and when they caught me off guard, they practically knocked me to my feet. Miles got a couple good laughs out of watching me, especially when this huge wave came that was as tall as me. It came all the way to the top of my head, and got me drenched. I didn’t mind though (: it felt good in the excruciating heat. We spent the rest of the day at the beach until the sun was practically gone. It was sooo nice, and we got a good joke out of the experience too! Miles kept telling me that I looked like I was negative haha. We went back to our hotel and showered to go get some food; we were pretty hungry. We found this Italian place called Panarotti’s on the water, and decided to try it out. We sat on the outside deck of the restaurant since it was still nice outside. It started to sprinkle just a little bit, which is quite rare for South Africa. I thought it would be a good idea to move under cover just in case. As soon as we got all of our things moved, it started torrentially raining like you wouldn’t believe. I have never seen it rain so hard in my life, not even in Seattle! We took pictures of it, because this was even rarer to be happening in Africa. It rained so hard, and the wind was blowing so fiercely that the power went out at the restaurant for almost 15 minutes! It was quite the experience. Eventually the power came back on and the rain subsided. We finished eating and decided to return to our suite. On the way out of our suite when we were searching for food, the gate leading to the parking lot was locked. The reception area was closed, and when this happens, they lock everything up so that the guests are safe. I tried to open the gate, and couldn’t. I thought this was the oddest thing; why would they lock a gate that we can’t get out of?? So, instead of trying to figure it out, we climbed over the fence. When we returned, the gate was open, so walked on in and closed the gate behind us. But, I was still stumped on why it was locked when we left since it was wide open now. So I told Miles to come figure out how they opened the gate with me. We both bent over the gate to look at the lock, and Miles hit it with his pinky and the gate came flying open. I have no idea why I wasn’t able to get this incredibly simple lock open when we were leaving, but I couldn’t!! And Miles just believed me, so we hopped over the fence…only to find out that I was stupid and didn’t need to do that…… (:

The maids here are so incredibly hospitable and kind. While we were on the internet (yayy), somebody knocked on our door. We unlocked it and found one of them with outstretched arms holding two gourmet South African chocolates out for us. She told us it was a gift (: how cute. I was very excited for the next morning, so headed to sleep in waiting for it!

Full Day

We saw so much today in quite a short period of time. We sat in with the doctors that were doing admittance, so there were tons of incoming patients with various ailments. We saw a man that complained of having a hernia for twenty years, so my question is, why is he just now coming in?? I got to feel the hernia too, which was cool. A hernia is pretty much a tearing of the layer just below your stomach, which is meant to protect the organs below it. The hernia was located right below the middle of his chest, in a triangle shaped area, and you could very clearly feel the edges of the tear, which was interesting. The area that is torn is supposed to be kind of painful, and he winced as the doctor applied pressure to show us where to feel. We also saw a man with Kaposi sarcoma, which is characteristic of some HIV and most commonly AIDS patients. This is a skin disease, where skin lesions appear on the body, and leave dark marks and scars where they were formed. This is a really bad sign, and usually only appears on progressed cases of the disease. He had it on his upper thigh. I have seen pictures of this in books from my HIV/AIDS research, but never personally, so this was interesting for me. We also saw a little boy that needed a circumcision. He was on ARV’s (Anti-retroviral’s for HIV patients) and this supposedly created a sore at the tip of his penis, so the doctor decided the foreskin needed to be removed. Next, we saw an 86 year old lady with esophageal cancer. She was very sickly, and at that age, there is not much you can do. He was going to get her admitted and try chemotherapy, but she is too progressed in the disease for it to have much of an effect, and she is too old to do surgery on. A younger boy came in with intense pain in his abdomen, so debilitating that he could barely walk. The doctor was guessing that it was either appendicitis or TB, but was learning towards appendicitis because of his appearance. They were going to do an x-ray and once it was confirmed, get him into theatre to remove the organ. Funnily enough, another young girl came in with similar issues, but this time the doctor thought that they appendix had actually already burst. She was going to get taken to surgery immediately, which in South Africa+ hospital time = hours away. The next patient, a woman came in wanting to get a keyloid removed. It was huge; the size of an orange on her ear lobe. I was curious why she hadn’t come in earlier as well—something of that size doesn’t grow over night. But, anyhow, she was in now. I didn’t hear what was going to be done in that regard. An older man came in saying that he had an inability to swallow for two years! I really don’t understand why these patients don’t come in right away. When you wait longer, whatever is wrong more than likely just gets worse and harder to fix. He was quite humorous. He told the doctor “I can’t swallow anything, but alcohol goes down just fine”. The next patient came in with chromo mycosis of the lower leg. It was hideous! This is pretty much growth and swelling, along with sores and bacteria. It was quite nasty looking, but she seemed rather unbothered by it; she was wearing a skirt and letting her whole infected leg be exposed. The next patient was an older lady with a breast cancer growth. Her uncancerous breast looked like a deflating bag, but her cancerous breast was completely different. It had a huge hard growth in it that made it stay higher up in place, and was pretty deformed with the nipple area was bleeding. I got to examine the cancerous growth, and it was rock hard. It was the strangest thing. This next patient is an interesting case. She wasn’t too old, maybe in her mid twenties, and was a firefighter (you don’t find many women with those kind of jobs here, and it shocked every one of the doctors and nurses). She was on the way to work for a night shift, and was attacked. The criminal stabbed her through the left side of her stomach, all the way through her organs diagonally down to her right hip. It had only been a month since this happened, and when she came in, she was apparently on her death bed doing horribly. But, she was in today looking very healthy and well, simply getting a check up to make sure everything was healing well. It was incredible. The last patient was pretty gross, but pretty common. She was diabetic and had some sepsis in her feet which had caused all of her toes to be amputated. Her foot was healing, and she was also just in for a check up to make sure the healing was going well. She pointed out that it was bleeding through the bandages a little bit, but I didn’t go into the examination room to take a closer look; that’s really not my favorite. She was our last patient of the day, and it was our last day at King Edwards.

We picked up our rental car right after work and decided to do something fun tonight since we had been doing so much work. We had been meaning to go to Florida Road, a fairly famous street with safe night life. It had been recommended to us by past interns, the program coordinator, and our host families. We got all dressed up for almost the first time since we have been here, and went out. It felt so good to get pretty again and go out to do things that felt familiar! I’ve missed it a lot! Florida road is packed with cool restaurants, clubs and cafes, as well as some shops mixed it. It was really fun. We found this amazing restaurant/bar called the Cabana to go to; it had a little bit of a Spanish flare, which Miles and I both liked. It was a really cool inside; they did a great job with the decorating and creating a warm atmosphere. We had amazingly yummy food and were very happy with our choice to come here. There was a huge table near ours with a big group of people occupying it. Two of the men at this table were incredibly drunk and we found them to be quite hilarious. The one guy kept shouting things really loud, and he was just so stupid. Even his drunk girlfriend found him to be embarrassing, so you know it had to be bad. The other guy was even worse. He thought he was the coolest thing ever, and was dancing THEE WHOLE time. He was horrible! And he was drunk, so everything was over exaggerated. My mom would have loved this guy; she would have peed her pants if she saw him going at it. After this, we had to go pick up Miles’ host brother Boom Boom from his school dance at a huge building downtown called the ICC. We decided to go back to the News Café at the Casino Entertainment building for a while since it was still sort of early and we were enjoying being out. We had some desert, the best chocolate cake ever, and some yummy drinks. We had finalized plans to go to Margate in the morning, so we headed home after this to get packed and ready to head out.

T.I.A.

Miles and I returned to the same surgery unit that we were brought to yesterday. We surprisingly saw some of the same patients that we saw the day before; I hadn’t really thought that we would for some odd reason. It seems like common sense when I think about it now. We saw the lady with the cellulitis lower leg again, the man with diabetic mellitus, and we also saw the hemorrhoid lady, which was quite unfortunate. The hemorrhoid had popped out already! I think this was due to the doctor not doing a sufficient job yesterday. So, we helped with the procedure to get it back in today as well. This time however, the doctor (a different one) got it all the way back in and bandaged up, so hopefully that doesn’t happen again, the poor lady! We saw a man with a bad head injury. He was assaulted with a shovel, or a spade as they call it here, and brought into the hospital very intoxicated. He didn’t really have any memory and was kind of out of it. He had a huge wound in the back of his head that broke all the way through his skull and into his brain matter. He had bleeding inside of the subarachnoid space, a layer in between the skull and brain that is only supposed to contain cerebrospinal fluid. As a result, he was experiencing body weakness and slight paralysis of his left side. He needed physiotherapy, and they guessed it would take about a month for him to be almost fully recovered. Because of the extent of the damage to his brain, he would always have slight problems, but would regain most of his bodily abilities. The man across from him in the ward was an interesting case. He was very frail, you could see all of the bones in his upper body, and when we started looking through his files and saw the nurses changing his bandages, we noticed what was wrong. His left leg was amputated from just below the knee down, and his other leg was septic. He was a diabetic, and wasn’t taking very good care of himself. Septic pretty much means his leg was dead, and needed to be amputated. It was really huge, and black; it even looked dead. He had sores that were bleeding and almost rotting, with what looked like mold growing on it. The nurse described it as having an offensive smell, and she wasn’t joking. It was horrible. We saw a woman with a trache, but never saw her as a patient. But, we saw a woman who was in a taxi accident. The ‘mini-buses’ are quite dangerous and highly advised against, and crash often because of their erratic driving. She was in the mini bus during an accident, and had road burns all over her body; on her face and head, arm, elbow, shoulder and back. A nurse was trying to change her dressings, and it was really painful for her. I watched as she peeled the gauze and dressing off of her back and shoulder, and it was raw meat. There was no skin left, and quite a deep valley in that area, like a chunk of her shoulder had been gouged out during the accident. Blood was oozing through the dressing that was almost stuck to this raw area. As the nurse peeled it away, the woman winced in pain; I’m sure it wasn’t comfortable at all, and I know the air didn’t feel good on the wound either. The nurse had to clean it with sterile alcohol I believe, and the woman almost yelped. Then, the part that I think is the worst, she had to rub cream (I’m not sure what it was, but it was probably some type of sterilized antibiotic that helps heal the wound) on with a wooden popsicle stick all over the raw area, the kind you usually see doctors using to keep your tongue down when examining your throat. I cannot imagine the excruciating pain that must have caused her. The patient next to the car accident woman was an older lady that was in very bad condition. She looked as if she was mentally disabled in some form, had very scarred and pitted shins, what looked like gash wounds all over her body, and in poor general health. I was very intrigued for some reason, and headed to check out her file right before the doctor was coming to examine her. He told me he was coming to take out stitches that were in her eye, and that she wasn’t a very compliant patient. I read her file to find out that she was a stroke victim, which explains the disabled appearance of her body and of her mental state. I never found out what the leg sores were from, but I did discover the origin of the gashes; her SON had attacked her with a bush knife, which is a machete. I was in complete disbelief. How could your own son destroy you like that? She was already a vulnerable old woman. Now when I say stab wounds, in my following writing, I mean this man stabbed his knife into her quite deep, and then dragged the knife down, creating tons of wounds, probably three or four inches long on average, and there is no telling how deep. She had stab wounds on her legs, arms, hands, head, face and eye (the doctor was removing stitches that she needed here). She had a particularly horrible wound on the side of her head; it was very deep and wide, and was creating an inch thick tall scar. I was heartbroken by her, and wanted to know why the son had done such a thing and what was being done. This doctor explained to me that because of the already vast limitations the hospitals in South Africa face, they had absolutely no resources to worry about social or legal issues. He said that a social worker was assigned to the case, but what most often happens is nothing, either because of the lack of part by the victim or there are no resources for the case manager to do anything. The doctor didn’t even have a very detailed description about the events that lead to her massive injuries. The woman’s daughter had brought her to the hospital, but left without saying much or giving much information up. That was horrible to me, and the worst part is that this type of things is commonplace in South Africa. Can you imagine?? The last patient we saw had anal cancer, as well as of the organs close to this region. It was so bad and so progressed, that she had to undergo surgery to get these organs removed. She has no anus now, and I got to see what it looked like; it was all stitched up and crazy to see! Can’t say I see such a thing on a daily basis back home. Obviously her body still needs to get rid of waste, so they had to create a means for her to do so. They attached one of those bags that sits on your stomach (cannot think of the name) to her remaining organs so that it can be exited that way. She was in a lot of pain, and it looked quite gruesome, but at least she is alive and well. At some point of the day while in the hospital doing rounds, something on the floor caught my eye. I could have sworn I saw something whisk by quickly, so I casually bent a little to look down and forward under the table and bed before me, so as not to be noticed, and saw nothing. I figured my eyes must have just over exaggerated a small bug or something, only to a few minutes later discover that my eyes hadn’t tricked me, and I so wished they had! It ended up being a giant cockroach, in the hospital!!! Miles and I couldn’t believe it. The other nurses saw and were grossed out, but didn’t even try to kill or get it out, they just walked away because this is a normal every day finding. As Miles always says since his host family brothers enlightened him, T.I.A. man, T.I.A.! (This Is (most certainly) Africa)

Pretty Gross

It was a hectic one today. When we finally figured out which part of surgery to go to, we were immediately whisked to join rounds. Two doctors and a group of five German interns were all surrounding one patient; the interns moved aside and told us to have a closer look at what was going on. This man was a diabetic who was facing a possible leg amputation; his right lower leg was pretty much being eaten away by his own body. He had what is called diabetic mellitus, as well as osteomyelitus with gangrene. The muscles, ligaments and fat were all exposed; the skin had long since deteriorated and his body was now working on doing to same to everything that was now currently exposed. And, on top of his own cells attacking his body, everything that was now exposed, (the muscles, fat and ligaments) were becoming bacteria ridden, causing deterioration to accelerate. The head surgical doctor who led Miles and I to this great team also happened to be an expert, and this large group wanted his opinion on the amputation. The patient’s leg was really bad; they were torn whether to try applying this ointment and special bandaging to see if it would get any better, or if it was too far gone and needed to be removed. The final decision was to give the ointment and wrapping a try for a few days first; they wanted to help him save his leg, and he was so happy for this. They might even try debriding the area as well. Apparently leg amputations are a very common thing here, however, with around 12 amputation surgeries occurring daily. That is mind blowing to me! I think this can all be attributed to the lack of access to needed medication, such as insulin for some diabetics, as well as their culture—many people walk around with bare feet in South Africa; I am still surprised to see so many shoeless feet everywhere. And, bare feet are a huge no-no for diabetics. Almost all of the patients that I have seen in the hospital have horrendous feet, with black toe nails and sickly and infectious looking dark circles and dots covering the soles of them. The next patient we saw had cellulitis of her lower leg. It was very huge (almost like elephantitis) and very swollen, causing the skin to be very raised and deformed, as well as very red and tender. Cellulitis is pretty much when the cells of the skin become infected and swollen. This can even affect the muscles as well, causing increased swelling. I believe this was the case of the patient; her leg was extremely large. She apparently has had cellulitis of the same lower leg in 2006; she even had pockets that needed draining back then which left many scars. The next patient was quite disturbing to say the least. You might want to brace yourself before reading. She had a prolapsed hemorrhoid; it was the largest thing I have ever seen in my life. Miles described it, very accurately at that, but gross to think that it is a valid comparison, as a strawberry frosted donut with white sprinkles. It was HUGE. You can’t even imagine it without seeing it. There are four types of hemorrhoids, and this happened to be the type that comes out of the anus, as hers did. She apparently had trouble with this before, but was able to get it pushed back in. She had a baby about a week and half ago, and this caused it to pop back out. This is clearly a problem, as it causes A LOT of pain, and is in the way because of its excessive size. It is my understanding that she was taken to theatre soon after giving birth to get it put back in, but somehow it came out. So, yesterday, they were going to try another attempt at getting the hemorrhoid inside to increase comfort. It can be removed, and I’m absolutely not sure why they don’t just remove it now, because it needs to be removed eventually anyways; beats me. Anyhow, Miles and I observed the procedure, which happened right in her bed (nobody in the hospital has their own room, just mass rooms with probably 30-50 patient beds in them) with the curtains drawn! She was given a light anesthetic; it made her sleep, experience less pain, and ‘erases’ her memory of the event. But, during the procedure, she was still wincing in pain and trying to move the doctor’s hand, so she was unconscious yet semi conscious at the same time. It was pretty gruesome. It was never fully pushed back in, but still bandaged up and the procedure was considered ‘done’ by that particular doctor. That was the last round of our hospital day; kind of a bad ending, right??

The cars, and most particularly the big semi trucks here, have exhausts that blow out thick black smoke. The smell of it, mixed with all of the factories here that blow out the same smoke, makes me feel like I’m breathing in strong dangerous chemicals. I try to hold my breath in areas that are the worst because it scares me! Uncle Roy, our driver, has a mini-bus as they call them here; that is what all of the taxi driver’s use as well. His is a VW, but we would call it a van. He adores that thing like no other. Miles and I call it his beloved mini-bus. He inspects it all of the time, and opens the car doors for us so that we don’t wreck the doors by opening them ourselves. It’s the funniest thing ever. I have also wanted to catch a picture of pick-up trucks here; I have been unsuccessful thus far but will for sure get one by the time I leave. They are just regular looking trucks (the smaller ones), and the trucks are full of people at all times, every single time you see one. Sometimes with men off to work, sometimes with a whole family or two, or sometimes just children, but they are never empty. And you would be surprised how many people they can squeeze into the truck bed. I have seen what looked like 25! And some people even stand up in them which makes me feel extremely weary and nervous; I will never get used to some things here. I appreciate the amount of safety most abide by in the United States.

Endoscopies

Today was rather slow at King Edwards. We pretty much searched all morning for something to do since surgery was only doing pre-op check-in’s today. We finally found something in endoscopies. We watched two of them, and that was the extent of our excitement today; like I said, pretty slow. The first procedure was a very sickly rail thin old man. He had esophageal cancer, and wasn’t taking good care of himself at all, plus I think his sickness was progressing. The scope had a little ‘clamp’ on the end that was collecting tissue samples, a biopsy, of the cancerous cells. It was pretty cool to see the inside anatomy, especially because of his particular sickness. First of all, the cancer was clearly visible as black spots in his throat; very neat to see. And then, because of the type of his cancer, he coughed very often, and it was so cool to see the throat contract in and out from the inside. This must be a good field for me if I think such things are cool haha. The second patient, a woman, was believed to have internal bleeding. The endoscopy was simply to figure out where it was stemming from and if there is a non evasive way to fix the problem. Medicine is amazing in how advanced it has gotten. But, South Africa is lagging behind just a bit; the endoscopy was supposed to be in color, but was functioning in black and white for some odd reason, and was also glitching just enough that the doctor stopped to procedure until the machine could get fixed or another one became available. The problem in the hospitals here, as I have observed and heard all of the doctors complain about, is the lack of supplies. This is in regards to medicinal availability, equipment availability and reliability, and access to a solution to these problems. There were only two scopes in the whole hospital, one of which was functioning below standards. There were no other machines available for use any were in the surrounding area, and no guarantee that somebody could be found to fix the malfunctioning one. There is also lack of medicinal stock and availability; if a drug runs out, it will not be in stock again for about an average of four month. That simply astounds me. The availability of these drugs, medical supplies and equipment in the hospitals is already severely low, but then to have to deny patients care for up to four months because something runs out is mind blowing. It most certainly bothers the doctors working here, as I have observed and been told. It bothers me too, and I’m not even a doctor yet. I don’t think I could work in a place with such limited resources; I wouldn’t be able to handle denying patients needed care because of the poorly funded conditions of the hospital I work in. I am so grateful to have the opportunity to work in the United States where something like that is unthinkable. The two endoscopy patients weren’t sedated—they were only given a spray to the back of the throat with a numbing agent to help reduce the feeling. But, this really isn’t very effective; the woman was gagging the whole time the doctor was trying the procedure. I remember when I got an endoscopy done a few years ago to try to figure out what was going on with my stomach, and I was terrified! I can’t even imagine having to be awake, watch and feel the procedure taking place down my throat and further into my body. I’m also so grateful for the resources that are available to patients in the United States, and that I was able to be knocked out for that one! As I am here in South Africa working in some of the ‘better’ off facilities and witnessing atrocities of some form all day, I realize how blessed I am for the smallest things that would rarely cross my mind on usual occasions in my regular life. I truly think it is a blessing that I was able to come out here to see all of this and have my eyes opened and my heart humbled. As hard as it may be, it is showing and teaching me invaluable lessons on top of an experience that I will take with me for the rest of my life.

Waayy Too Many Bugs

As we passed this bakery factory on the way home from rotations today, it reminded me of something that happened last week. On Friday when we picked up our rental , Uncle Roy, our driver was giving Miles directions home, and one of them was “when you smell bread, turn right”. Later on when we were driving passed the bakery and Miles remembered, he told me and we couldn’t believe Uncle Roy thought those were legitimate directions; how funny!

Today was kind of an interesting day. It was our first day of surgery clinic. We didn’t know exactly where to go, so we headed to see the head of public relations for the hospital to direct us (she directed us to pediatrics and introduced us to the head doctor in that clinic on our first day last week). We also wanted her to introduce us to the head doctor so that we could find our way around better and get a good experience out of it. When we arrived, she was in a meeting that wasn’t going to end for another four hours! We decided to branch out on our own and go ahead to the surgery clinic. We found the main patient rooms; three mass rooms with four doctors in one, two doctors in the second, and one doctor in the third, with three check-up rooms in between the three rooms. We met the head doctor, and found another out of the group to shadow. He was extremely intelligent; I could tell as soon as he started speaking to us. We walked in at an awkward time, however. He was in the examination room with a male patient, just starting to check him out. So we quickly put on some gloves to get started with him. The patient had a smallish hard mass that you could feel in his stomach, and the doctor had already found him to have an enlarged sigmoid in a previous exam. The symptoms were still persisting however, so the patient was back. After we felt his stomach, the doctor had this patient lie on his side with his pants all the way down, and quickly shoved his hand up the man’s butt to check for ulcers. Yikes. Way to start off our morning (: The next patient that came in had a benign melanoma lump in her breast that was really bothering her and causing some pain. She opted to have it removed, and made an appointment for surgery in two months. Did you know that the hospital is closing their day surgery clinic for six weeks for the world cup?? So this girl has to wait until after that closing period to have her surgery—unbelievable. Mini was also telling me that school is closing for a month for the world cup; imagine something that like happening in the United States! Anyways, we saw a few more patients with this doctor. The last patient was in with an abscess, but a misdiagnosed one. She had tons of tiny abscesses on her butt (of course), and in South Africa, instead of taking a skin cell tissue sample, they make a fairly large rectangle incision where the ulcers are, deep enough that uninfected flesh is surfaced. It’s pretty brutal. After they did this, they discovered that the ulcers were just below the surface of her skin, and could be treated without drastic measures. They were all gone and healed now, but she is left with this huge hole in her butt from the incision, probably about the length of my palm and half the width, maybe an inch deep; it’s not a little thing, it’s seriously huge. The doctor was just checking to make sure the skin was healing well and that no new abscesses were forming.

Clinic was now over for these doctors, and they headed down to theatre for minor surgeries today. The only problem was that all of the doctors started leaving the room one by one, while the nurses and some patients were still in the patient rooms, including us. We didn’t realize that all of the doctors were leaving until I thought about it, and looked out the door to see them all walking off together. We grabbed our stuff to go and find them, with no luck. We got lost first, and then eventually found a wandering nurse to ask where the specific theatre was. It ended up being in the basement accessed down some odd hallway, and the doctors from clinic must have already scrubbed in for surgeries, because when we arrived, we just saw a bunch of nurses and other doctors scrubbing up to go. We didn’t know any of them, and instead of venturing into possibly horrendous procedures, we decided to take our lunch, since it was noon already anyhow.

We have found this cute café called Circus that is located in the mall about five minutes walking distance from King Edwards that is run by an older Dutch couple. They are the sweetest people, and since there aren’t many eating options (very different than in the United States), we decided to go back; that was probably our fourth time since being at King Edwards. When we were there, Roy called to pick us up an hour early for no apparent reason, so we never ended up going back. Hopefully tomorrow we can meet a surgeon and get in there.

I walked into the bathroom tonight to run myself a bath and all of the sudden the biggest cockroach I have ever seen just comes sauntering into the room! So I run and get Mini, who doesn’t want to touch it either, so it just keeps crawling around in there. We go to get Mzamo, who is sleeping, so mini grabs the broom from the kitchen like that’s going to do something, and then the cockroach isn’t in the bathroom anymore. It’s just gone! I never took my bath because my luck it would come crawling out of the drain in my tub. I’m pretty much traumatized; I really can’t handle bugs. And now when I have to pee in the middle of the night it’s not going to happen…my stomach is just going to have to hurt until the morning when I can see! That’s the most horrible thing ever ): Later on in the evening when I was going to the bathroom to brush my teeth for bed, guess what was waiting to greet me outside of my bedroom door? Yep, of course the mammoth cockroach. I went to wake up Mzamo and he chased the cockroach (I don’t understand why they don’t kill it) until it went under the front door outside. That didn't make me feel any better because that means it can just come right back if it can crawl under the front door. So I proceeded to the bathroom only to find two of its babies greeting me at that door. Auh! One of them, the largest, disappeared (the worst ever) but the other one was really tiny and I was able to kill it. I’m all paranoid now and feeling itchy and gross, and went to the kitchen to spit out my mouth wash, gargled and looked up at the ceiling and found a huge lizard looking down at me. It surprised me, on top of my already shaken state, and I probably jumped three feet out of my skin. I quickly turned to the sink to spit out my mouth wash so I could go back to my room and found huge African ants crawling all over the counter by the sink!!! I feel sick. And then to top it ALL off, I went to go pee before going to sleep and found the dad cockroach just sitting on the toilet! ): I woke Mzamo up to kill it, and he finally did this time. I slept with the light on because I was so paranoid. I already know that all of you are going to laugh at my fear and attached story, that one never fails (ahem …Chyna…), but I seriously want to leave this house. I can’t handle this.

Superbly Sun Kissed

Since we woke up to sunshine (yess!) we decided to skip the safari and head back to Durban for the Indian Ocean. We would be doing the safari on our own, which means we would be driving around this huge amount of land in search of wild animals that are big and strong enough to stomp on our car and crush us, if we even found them. We both decided that we were happy with the animals we had seen on the cruise yesterday, and headed back. I was anxious to make up our beach day that was supposed to happen yesterday. We made it to the casino resort/beach by 12:30 and basked in the glorious African sun for almost three hours. There was a lovely breeze coming in from the ocean which cooled down the unbearable heat to one that you never want to leave; it was perfect! We were so happy, and our bodies were too! I think Miles and I needed to replenish our bodies from the sunless weather in Seattle. We are now both superbly sun kissed (: It is the strangest feeling to look at the ocean and think that I am at the bottom of the world! First of all, realizing that I am at the bottom tip of Africa is insane, as we were standing at the Indian Ocean coast, and second, knowing that there is nothing else further down the ocean except for Antarctica is both cool and scary at the same time. The waves were pretty serious today, so we didn’t even attempt to step into the water. We have been warned multiple times about the strong current that carries bodies away…we didn’t want to take a chance. Plus, we were happy to be in the sun and sand period. We had lunch at the casino building, and then decided to head down to the gateway mall. But, we found out while thinking we were driving there, that we were actually driving home (same freeway, but gateway and home are in opposite directions) so we just decided to go home since we were practically there.

Tomorrow is back to King Edwards, except we are in surgery this whole week. Both of us are nervous! Our day in surgery at St. Mary’s didn’t go too smoothly. We are thinking that it might be a challenging week, and if we aren’t able to get used to it by Wednesday I would say (if we even last that long), then we will look for a different hospital ward to work in for the remainder of the week. We will see! Hopefully one of us don’t pass out; we will pack tons of water, anti-nausea medication, and bananas, and will be sure that chairs are in close proximity to theatre for easy access if suddenly we find we need to put our head between our knees….

Rain in St. Lucia ):

So Miles and I woke up to RAIN!!!! Can you believe it?? I was soooo mad; today was supposed to be our hot and sunny lazy beach day ); and it was clearly not going to happen anymore. And it never rains out here, so that was really maddening—of course it would rain the one weekend we made it up here. So, we had to improvise! We left the villa and went to the safari booking place to set up our hippo/crocodile safari cruise for later in the day, and to find out about the half day big 5 safari the following morning. But, we found out that the half day safari started at 5am….meaning we had to meet at 430 am…which wasn’t about to happen. So we opted into going to the game reserve on our own little safari in the morning instead—that way we could start at a more reasonable time. The beach and pool was clearly out of the question as of now, so we visited the craft hut again in search of more cool items to buy. We found tons…well…more like I did! I’m so excited to send out all of my gifts and for the cool finds I got myself. Since this is a beach resort with estuary wildlife, they have tons of surf shops, and Miles was in search of something cool and South African-unique so we looked through all of the shops down the main road. We had a very nice time. Then we got groceries to cook tonight, and headed out on our hippo/croc safari cruise. It would have been an even better cruise if it wasn’t grey, cold and wet. But, that is ideal hippo weather, and we got to see a ton of them, which was lovely. Not so ideal weather for crocodiles though, so we didn’t see any. We got to see a very interesting thing though; hippo’s mating! Apparently, hippo’s only mate every three years, and we by chance got to see the hippo’s mating today on our cruise. It was quite an odd experience. The male pretty much stands on top of the female, who is under water. Hippos can hold their breath for up to three minutes, so every three minutes or so she would try to come up for air, and the male hippo would push her back down with his legs; kind of funny. And their ‘children’ were standing on each side of them while this was taking place; it was a family affair. Luckily it was all taking place under water so we didn’t have to see whatever else was going on. The tour was two hours long, and by the time it was done, we were pretty cold. Both Miles and I assumed it was going to be hot and steamy outside, just like it usually is every single day in South Africa, so we only packed shorts and tank tops. We were not prepared for the cold rain and weather today. For the cruise, we brought along these huge fuzzy blankets from our villa to keep us warm and everyone was looking at us strangely, but we were toasty and that’s all that matters. Miles had (oddly enough) brought this chocolate truffle hot chocolate/chocolate milk mix, so we returned to our villa and had this gourmet hot chocolate with cookies and muffins. We stayed at the house for a while, and then decided to go search for hippos! The tour guide on the cruise told us that since this is the hippos favorite weather, 20 times out of 30 you can find them walking in the town down the main street; we wanted to see! But, instead of finding hippos walking through town, we found a completely deserted one. There were hardly any people out because of the torrential rain shower, so we turned around to go back to our villa to cook.

Miles and I made a good little cooking team. We were going to make pasta—I was craving it since my home stay doesn’t make it and it’s practically a staple at my house. We found all of the ingredients at the grocery store earlier that day and we ended up making such a gourmet meal; Miles took a picture because he was so proud haha. We made pasta with sautéed yellow peppers, crumbled bacon and a mushroom tomato sauce, garlic braii rolls (braii is South African barbeque), green beans sautéed in garlic and butter, and fresh avocado from the craft and fruit market. It was very yummy. Then we played cards for a while and didn’t do much before heading to bed. We are crossing our fingers for sun tomorrow!

Weekend!

We were in pediatric rounds again today with Dr. Ramji. A lot of the patients from yesterday had either been discharged or moved to a different ward during the night, so there were only a few patients left this morning to see. But, as this is a teaching hospital, and Dr. Ramji is very thorough, the same amount of time that we spent on all of the patients yesterday was spent on these few remaining patients; we were with each for a very long time! The same child from yesterday who had cardiac arrest was still here today. She was eight months old, HIV positive with pneumonia, malnutrition (including a potassium deficiency which had caused her muscles to be non-reactant, as well as sepsis), persistent diarrhea and had gone into shock from cardiac arrest. Dr. Ramji had explained to us that when a child is revived from cardiac arrest, they most often develop brain damage that manifests itself around six months later. She was getting tests done to figure out what exactly was going on with all of her illnesses, and being monitored for possible brain damage. We stayed with this one for a very long time. She was so sick and so tiny. I felt terrible for her; I’m not sure how great her chances are looking. We saw a young girl who had an abscess on her eye lid (!!) that needed draining that came in with respiratory abnormalities for monitoring. Then we also saw a nine year old boy that came in needing a blood transfusion. He was HIV positive, stage three, with terrible oral and esophageal thrush and sores. He was so weak and definitely needed the transfusion, plus couldn’t eat because of the pain the thrush and sores were causing him. He was administered medication to help the sores go away, and while looking through his files, Dr. Ramji discovered a slight issue with his CD4 count and medication; ARV’s are supposed to help keep your CD4 count higher and ranged from your viral load. If this is not the case, or if these two counts are coming closer together, that indicates that the strain is becoming resistant and treatment is becoming ineffective. Usually a doctor that keeps good track of their HIV patients would have put this child on a different ARV medication regime or upped the current doses to get these numbers back to where they need to be. But, this apparently didn’t happen because this little boy’s numbers had been steadily merging for the past few months, which is horrible news. Dr. Ramji ordered that his CD4 count and viral load be retested and that he be put on an upped dosage of medication to help him progress rather than digress; his condition is already bad enough. He needed a blood transfusion every three weeks! There was another little girl we saw that was in with abdominal pain, which was assumed to be some type of worm, that we also discovered had a heart murmur. A small child was there for diarrhea and fever; nothing too serious, but the final baby was quite a severe case. He was born with fluid in his brain because his mother declined to have surgery during her pregnancy to correct the problem. So, he has a very large elongated and deformed head; all of the extra fluid is at the bottom of his head, by the nape of his neck. It was the strangest shape and largest head I have ever seen. He had a shunt put into his scull to help drain the fluid, but because the mother didn’t take care of the problem in the womb, his head will never be a normal shape even once the fluid is removed. He was in the hospital to be monitored and because the ‘wound’ where the shunt was put in the back of his head was oozing pus and swelling, which is not good. If the pus gets into the bloodstream it will poison him. That was the last child of rotation.

Miles and I left a little early; we were successful in securing a car rental, and an automatic at that (you have no idea how hard it was—everything is manual here), and needed to quickly book a flat in St. Lucia so that we could head up there for the weekend. We were going to wrap up the plans at the university’s computer lab before coming to clinic, but every single computer in the whole university was reserved for test taking until one pm (can you imagine that happening at any other university???) and we didn’t have that time. So, we left clinic early to walk up to the mall for the internet café. And, luckily enough, we were able to find the perfect villa for our stay! We were so happy to finally get our plans set and worked out for St. Lucia. We picked up our rental and made the three hour drive to the resort. The drive out there was amazing; the land was beautiful—we actually got to see some African trees and grasslands that were uninhabited for the most part, as well as random clusters of mud huts off of the sides of the freeway. It was pretty incredible. Driving was also an interesting experience. Firstly, everything is on the left hand side, driving and the driver’s seat. And then, everyone drives rule-lessly! The shoulder of the freeway was made into an additional lane that people were driving on! And it wasn’t even wide enough for it to be a full lane, so the cars were driving over the yellow line, causing all of the drivers in the real lane to drive over their lane, which was right next to opposite traffic; scary! And, when there weren’t any cars coming up the opposite lanes, drivers even drove in those lanes! It was quite a scary, interesting and fun experience.

When we finally arrived, it was around 7 pm. To our surprise, our villa was amazing! It was huge; we had our own car garage, a very large living room, dining room, and kitchen, plus two huge bedrooms each with their own en-suite bathrooms. We also had a barbeque, a patio with a cute little table set, and a nice swimming pool right off of the front patio. We were so excited! Everything had worked out very nicely, which we weren’t quite expecting. We got all of our things put into the house and decided to go explore and get some food. There was an amazing thatched roof craft hut run by villagers down the road with huge fruit stands that we were anxious to visit. And of course, it was incredible to say the least. We bought amazing fresh fruit and tons of neat little African crafts for ourselves and for gifts. Then we went for dinner at this seafood/steak restaurant that was outside under a thatched cabana type deck. It was very yummy; Miles got ribs and prawns, and we were both very surprised to see his prawns arrive ‘un-skinned’. The ‘face’ and claws and skin were still on the meat instead of already peeled for you. He had to take a picture because we had never seen anything like it. It was actually kind of scary, I’m glad they weren’t mine! We headed back to our villa to get some sleep! Tomorrow we were planning on going to the beach and visiting our pool (we both want a nice tan to come home with), going on a hippo/crocodile safari cruise, booking a half day safari for Sunday to see the Big 5, and then getting groceries to cook in our huge kitchen.

Pediatrics

Before I summarize my day, I wanted to bring up something that I have been thinking about in regards to my writing. I know it is often said that Americans are egotistical about the United States, and tend to be ethnocentric, thinking the United States is better than every country. It has crossed my mind that I might have come off as such during my writing, and I just wanted to clarify. I do not believe that we are better than anybody else; rather I know that every country does things a little bit differently. I most certainly know that I sometimes prefer the methods used in the United States simply because that is what I am familiar with; just as anybody else with their home countries and associated customs. It is comfortable and familiar, and we tend to lean towards the two in all regards. While writing, I know that I compare the United States with South Africa, and that is purely because it is the only other thing I know well enough to compare it to.
As for my day, it was quite long and full. We started rounds with Dr. Ramji in the general pediatrics clinic today, and he is an absolutely astounding doctor. He makes sure to take his time to explain things thoroughly enough that you understand, and clarifies if you don’t. He makes you think about things critically, and actively involves you in the conversation, which is the most effective way to learn. He is such an intelligent man, and knows his stuff very well. It was so great to follow him around today. King Edward’s is a teaching hospital because it is on the premise of the University, so there were many other interns (doctors finishing their fellowship) and students in the midst of school that came along on rounds with Dr. Ramji, Miles and I. One of the interns had gone around to all of the patients to familiarize himself with each before Dr. Ramji and the two of us had arrived. So, the first thing we did was go around quickly to each patient while the intern gave us a brief case study of each child and what he was doing for them, or what he was thinking should be done for treatment. The doctor would ask the intern why he decided such treatments or diagnoses in order to solidify his understanding and confidence in his knowledge, and would explain things along the way to help with both. But, this was rather quick and quite un-thorough. We waited just a little bit until some of the other interns and students were out of a meeting to start going through each patient’s cases more thoroughly. This was what was really informative and great for my understanding today. We spend around 30-50 minutes with each patient, examining the doctor’s notes, test results, x-rays, medical history, and the patient. He explained the notes, test results and diagnoses very well, asked us questions to make sure we understood, let us feel and see the things he was explaining on the patient, or on the x-rays etc. It was so informative and I really felt like I learned first-hand today.

We saw a lot of pretty sick children. The ward was packed! Rounds took an extremely long time; my feet were starting to hurt from standing for that amount of time. There were children in the ward for everything; diarrhea, dehydration, malnutrition, pneumonia, HIV, respiratory issues, measles, cardiac arrest, acidosis, fevers and such. Dr. Ramji gave us stethoscope tips and let us examine all of the patients with him. He slowly showed us everything that he wrote in the notes (all that he was seeing, findings from examination, etc), showed us his findings from the x-rays and blood results, what he was thinking was wrong based on all of these, explained why he figured it to be such, what he can do for the patient, what is the best method, why he will prescribe medication and which kinds, and the final treatment or tests he is ordering for the patient. It was so great, and I really appreciated all of the time he spent with us.

Plans Interrupted

I had an interesting morning today. Firstly, I went to sleep at around 10 pm, which is pretty early for me. And I must have forgotten to set my alarm, because my brother Luyanda came into my room asking me if I had had my breakfast yet, and I was still asleep. I thought that he must have come in before it went off, only to check the time and find I had 25 minutes until Roy arrived. I rushed to get ready, and then Roy was 15 minutes late anyways! Upon arrival at King Edwards this morning, we discovered that none of the doctors had shown up for rounds. None of the nurses knew why they hadn’t shown up, they were guessing a meeting, but no matter, that left us with nothing to do! Since we were at the hospital that is attached to the University, we stopped in to get on the computer. Our driver Roy couldn’t pick us up that early (we were there for about one hour before we called him), so we went to check back in the pediatric clinic to see if any doctors had shown up with no luck. So, we headed back to the computers for two long hours…we had absolutely nothing to do. Finally Roy was able to come and get us. He took us to a place that serves famous bunny chow, called Govender’s. Bunny Chow, as gross as it sounds, is a very popular curry dish here, one that we had to try while here. It was actually quite good! It’s curried meat of your choice (usually beef, chicken or mutton), with potatoes all in a homemade bread bowl. It was really spicy, but good. While at the restaurant, we asked for water, and were responded with "sorry, we don't have water, only coke". Both Miles and I looked at her with wide eyes and gaped mouths; I would have never dreamed of hearing this in my life. South Africa has done this to us a few times; surprised us so much that we have no words, just exchanged blank stares. When I arrived home, I found that Vusi, my host father’s mother, had come to visit for the day. Our maid Zotua was here today as well, and was busy in the kitchen cooking lunch for everyone. I was so tired and went to take a nap which ended up being two hours long. When I woke up, my hand was itchy, and dang it I had a huge mosquito bite right smack in the middle of my palm. I’m so mad!

My family made me eat when I woke up; they feed me so much here! I swear I’m going to be portly when I get back to the United States. They are really good cooks, but the food they continually eat is so much more dense than I am used to. Every night, we have some sort of meat, with tons of rice, usually potatoes or sweet potatoes, a salad, and then yogurt, custard and cream for ‘dessert’. The portions they give me are huge, on top of the very dense food. Auh! I’m trying to tell the boys to give me smaller portions because I can’t keep eating that much; it makes me sick, but I don’t want to appear rude to Zola. It has worked well so far (: They eat so healthy here too, which I had never thought about upon arriving. Each morning for breakfast they feed me whole grain cereal with 2% milk (like I said, everything is so dense!), and then dinner and lunch are the same type of things; rice with curried meat and potatoes, sometimes a salad and fruit and then yogurt occasionally with custard and cream. It kind of reminds me of Great Grandma Martinez’s house, always trying to feed me so much! Coke is also a huge thing here; they absolutely LOVE it! And juice! I have never seen so many types of juice at a grocery store in my life—juice takes up a whole row in the grocery store. It’s all fresh from the fruit off of the trees here, and very good. I keep trying to drink water, but they usually ask me why I’m not drinking juice, so I end up drinking it anyways. Deavon would be in heaven here; he loves juice.

I don’t think much else is happening here today—quite a few uneventful days! I’m ready for something exciting to happen. Hopefully tomorrow goes well at the hospital. Thursdays we have meetings with our medical director, Dr. Kahn, so we have that meeting right after the hospital. I missed it last week because Thursday Dr. Kahn wasn’t available to meet, so he pushed it up to Wednesday, and that was the day I stayed home sick. Miles has told me he is the quite the man; he runs many clinics all over Durban and Cape Town, and is apparently booked back to back every single day with meetings or appointments of some sort, so the meeting was very rushed. Miles said he didn’t get any words in the whole time; he just quickly jotted down notes as he spoke in order to keep up and remember what Dr. Kahn was barking at him. Sounds a little crazy! I’m almost at the end of week two already, and have been away from the United States for almost three! Time has quickly passed, which I am grateful for because I definitely miss home. But, I know that I need to take things as they come and enjoy my time here while I still have it. I’m sure the rest will fly by just as fast.

Return to Work

First day back to work! We are at King Edward’s Hospital and attached University of KwaZulu-Natal for the next two weeks. This week we are spending our time in the pediatric unit. We met a very nice doctor named Dr. Ramji, who brought us to the Infectious Disease clinic for the day. We will rejoin with him for the following days of the week. In the Infectious Disease clinic, we met an almost doctor; he finishes his fellowship in August, and then is done! He was great, but I didn’t catch his name. He was from the Democratic Republic of the Congo, and had a very heavy accent. We were only told his name once, and that one time I wasn’t able to understand. We met another fabulous doctor named Dr. Ramjee (must be very common here!) who allowed us to shadow her for the day. The consulting rooms of Dr. Ramjee and the Congo doctor were right across the hallway from each other, so we periodically switched rooms to see what was going on with each of them. We spent the first part of the morning with the “Congo Doctor”. He was just doing pretty routine and quick checkups. We saw quite a few HIV infected children who just had routine checkups (checking lymph nodes, mouth, heart rate and lungs, etc) and were there to pick up more medication to continue their ‘cocktail’ treatment. We saw a little girl who was on TB treatment and was there to see a gynecologist; she was six years old and had been sexually abused, with vaginal and anal mutilation and a strange discharge. I felt horrible for her. She was the most beautiful little girl too, and quite shy and reserved, I’m assuming partly stemming from the abuse. She is way too young for such a thing to happen; that breaks my heart. We sent some patients to get their blood drawn for new CD4 counts, and prescribed multivitamins and other medications to the children on HIV treatment. We switched rooms to work with Dr. Ramjee. We were immediately asked to help her draw the blood of a very young girl; two years old at the most. She was already crying and scared, as if she knew exactly what was coming because she had had it done so many times; poor little thing! The needle was in her wrist, and I can’t imagine that feeling too good to a small one. Blood drawing is a completely different thing over here! When I was getting my phlebotomy certification done, we practiced using vacutainers; the little tubes that hold blood that are placed onto the end of the needle tube for quick and clean transferring directly from the body. They had vacutainers here, but not the tube that is connected to the needle for transferring blood from the stream directly into the tube. Instead, the doctor held the needle with an end opening, and had Miles take the lid off of the vacutainer so that it’s just an open glass tube, and she let the blood drip from the back of the needle into the glass tube! Because there was no certainty in this other than the steadiness of her hand, some blood dripped onto her glove, the floor, and down the outside of the tube! She needed to fill three large tubes, so each time that she filled one up and needed the next, blood just dripped onto the floor until she got the next tube from Miles’ hand into the right position under the needle. I was absolutely dumbfounded. Some blood from the large tubes needed to be transferred to smaller tubes, and this was done without certainty as well! The lids of the smaller tubes were taken off, and blood from the large tubes was poured into the small ones. Blood got onto the exam table sheet, and instead of tearing it off and replacing it, she simply sanitized the area and left it there. This child was getting her CD4 count rechecked, meaning she was HIV positive. I cannot believe the insanitation of the hospitals here! It blows my mind, and all I can do is stand back and gasp at what is considered normal and okay in the hospitals. The last patient of the day was the cutest little boy, who was extremely sick. He was three or four years old, so very young, and had stage III HIV with a CD4 count of 344. He had chronic lung problems; at an early age he developed bronchitis that was left untreated, causing major breathing problems. He has a permanent wet cough, trouble breathing, clubbed fingertips, and discoloring and spotting on his head, back and chest. To top it all off, he was being treated to TB. Dr. Ramjee said that just with his chronic lung condition alone, he is only expected to live another 8-10 years, not to mention his TB infection and progressed HIV condition. How sad is that? And apparently each time he is brought in for his appointments, he is brought by a different person, who knows nothing about his health status. Because of his seemingly unstable home conditions, Dr. Ramjee was also expecting him to eventually default, or miss taking some of his medication, and this is extremely bad, especially in such an advanced stage of HIV. Your body practically becomes immune to the drug regime and it no longer has any affects for treatment. A patient then has to go on both more medication and higher doses, or a different drug regime to try and fight the strain, but once this pattern of defaulting occurs a few times, the patient is pretty much doomed and eventually all treatment is ineffective. It was kind of an awful way to end the day, seeing this cute little boy and knowing that he isn’t going to live for very much longer. That’s a daily occurrence here, something that I could never get used to. I am so grateful for the health that the majority of the United States is blessed with, and for the amazing health advancements, conditions, and treatment we have access to. I most certainly took all of it for advantage before I came here, but never will I do that again. I am absolutely blown away each day by the little things I see that you would never in the U.S. , and things that you wouldn’t even think twice about. For example, the exam table sheet I spoke about above. In the United States, you assume that a new sheet was laid out for you before you arrived and that nobody has used or soiled it; there should be no doubt in your mind that it is sanitary, and you often don’t even think about such a possibility of it not being. Here, every patient that comes in that day sits on that same exam table sheet. No matter if blood got on it, or if the patient has TB and coughed all over it (both happened today); each patient sits on the same dirty germ ridden sheet. And it probably even sits there for longer than a day. I would not be surprised to find this true. We take advantage of so many things in the United States, and I didn’t even realize how severely we do it until coming here.

Update

Today was quite slow. Miles and I headed to the mall to get to the internet café, and they closed very soon after we arrived, cutting our time way shorter than we had planned. We headed back to his house and then were finally able to make it to the beach! We went to the Indian Ocean right behind the big casino entertainment building downtown. The sand was so nice and it was very warm and sunny, and the water was great, with huge waves! Miles and I also got a little tan in, which was exciting. And of course, I wore sunscreen (don’t worry momma ) We brought Miles’ brothers Boom Boom and Tulani. It was so nice to finally get out in the sun and the BEACH! It’s supposed to be winter here, yet it’s unbelievably hot; it’s so weird to be able to say that I went to the beach in the winter, and didn’t freeze my butt off. That was pretty much all that happened today. In the United States, something like this would probably take half a day, but because ‘African Time’ (that is what they call it here!) is so much different, it took the whole day. Everybody works more relaxed and slow paced, and takes their time to enjoy themselves. I’m not too used to that, and it’s kind of nice, yet kind of frustrating at the same time. Sometimes I just want people to pick up the pace and get on with things, and other times I enjoy relaxing and sitting back for a little bit; all depends on my mood. Overall I think it’s a good change for me, and gives me a break from my extremely busy lifestyle back home.

Lizards ):

Nothing happened today! It was very uneventful just as I thought it might end up being. But happy Easter! (: May the Lord be in your thoughts always.

So in the houses in South Africa, there are these little vents (almost like floor vents, but way larger with grid-like squares instead of slots) on the tops of the walls in all of the rooms. And, as I have so joyously found out, things crawl into them from outside, like lizards!! I have been startled by something moving from the side of my vision many times, only to look over and discover a lizard crawling up and down my bedroom wall! I struggle so hard not to scream at the top of my lungs and refuse to sleep in this room anymore every time it happens, like I would do at home. It’s the hardest thing for me!! And they just crawl all around, or hide behind the curtain on the window or down behind one of the beds in my room as they please and then eventually crawl back into the holes and disappear. It is probably the most horrifying thing to wait for them to leave; I am frozen standing by the door watching them until I see them leave through the holes every single time it happens because I can’t do anything else! If you know me, you also know that my number one fears are spiders and insects of any kind. Insects are EVERYWHERE here and it’s practically killing me. I was walking to the little local mall just down the street from my home stay, and I was wearing sandals because it’s cooking down here, and all of the sudden it felt like bugs were all over my feet, and sure enough…I look down and find the most giant ants in the world (they’re humongous here I can’t even believe it!) crawling all over my feet; probably ten on each! And they bite down here and it stings a lot! So I was jumping up and down screaming and kicking my feet to get them off of me, while my host brother stands there laughing at me because bugs are nothing to anybody that lives here. I wanted to cry as soon as I got them all off ): and I have to spray myself with this bug repellent spray before I go to bed so that I don’t get eaten alive every night. The first night here (they keep all of the windows open because of how hot it is, and they have no screens) I got four mosquito bites on my lower arm, as I mentioned above, and I STILL have them! And they are still pretty huge and itchy…the worst! They’re so red too, and I haven’t even scratched them, amazingly enough. I’m afraid they’re going to leave scar-like marks on my arm. I’m getting itchy everywhere just thinking about it; euh that makes me shutter! Enough about bugs..

Fun Night

Today all that I did ALL day from 9am to 8pm was lie in bed and read my book. It was the hottest day thus far and it was scorching. You couldn’t even make a small movement without sweating and feeling dizzy because of how intense the heat was. Nobody in my house did anything today; they all lied in bed the entire day to stay cool as well! It was pretty miserable. And because it was a holiday, Miles’ family had their extended family over and didn’t want him to go anywhere, so we couldn’t go to the beach or the city centre, and the beach sounded like the best place on earth to be today. But, at around 8pm, Miles called me and said that he was so bored from being stuck in the house all day and wanted to do something tonight. So we made plans to head to the casino entertainment building to eat and get out for a while. Again, because of the holidays, police created blockades at all of the roads before the freeways leaving the city centre, and Miles’ host mom didn’t want them to harass him about his American license driving her car, so we decided to take a taxi instead. Miles invited both of his brothers to come, as well as two of their cousins that were visiting for the day, and I brought Minenhle, or mini, along with me. The taxi’s here are so different! Almost all of them are VW buses that blast techno music out of the all-rolled-down windows. And the taxi’s all have different names (I’m assuming the driver can pick his own ‘company’ name) that are posted on the top back of the bus in sparkly letters, and most of the names are hilarious! Like, Ghetto Boyz, Disco Biscuit, Boyz House, Pretty Pride, and Drive or Die. So, of course our taxi had to be just the same. It was the funniest thing to me to be arriving in such a vehicle, but it was transportation nonetheless. We went to this café called the News Café, and it was very nice. The odd thing about establishments here is that they seem to try to ‘mix’ venues and it just turns out weird! For example, they have this very common chain restaurant called Wimpy’s, and it’s a mix of Red Robin’s and McDonalds, it’s so strange! And, this café was an odd mix as well, of a club, a bar, and a café all in one. But, we ended up having fun. Miles, his brother “Boom Boom” and I were the only ones that came here (age restricted), while the other four went off to play in the arcade and get food of their own. It was very enjoyable to be out and doing something that feels more familiar to home; we both liked and needed that. We aren’t sure if anything will be open tomorrow, because it’s a Sunday and a holiday weekend, but we might try to get to the Gateway Mall, a huge mall downtown, just to get out and to also hopefully get to an internet café. Hopefully they are open! If not, then it might be another uneventful day, minus going out at night.

Recap

During rotations yesterday, Miles and I talked to the sweetest girls. They had been given a tour of the hospital at the same time as we did when we were first arriving at St. Mary’s on Monday, so we recognized them. We were just finishing our pediatric rounds for the day when one of them approached us and asked if we were from the United States. We responded, and she had questions for us about our schooling and how we went about studying abroad. She ushered her friend over to talk with us as well, and we told them about medical school in the United States and studying abroad, as well as answering the few other questions they had. They asked for our advice about pursuing medicine, as they were hoping to do so also. They were so cute, and quite a bit shy. I was very surprised to find them almost awe struck by our presence in Durban, so much to the point of being timid to approach us for advice. We were so happy to give it, and encouraged them to find their passion and go for it with all of their heart. We wished them well, and left St. Mary’s for the last time. I really hope that they stick to their dreams; I would never be happy if I didn’t follow my heart myself, and that was the best advice I knew to give.

Our weekend plans didn’t work out, as we guessed it. We woke up early to head to the local mall to visit the internet café to try our luck one more time for St. Lucia, but it was closed! The sign on the door said it wasn’t supposed to close until one, but was subject to change at anytime….we were there at 11:30, so that must have been what happened, as today was a holiday here. We were sort of frustrated, because that was the end of St. Lucia right there. We went back to his house, and played sorry with his brothers for a while; they are the nicest two boys, just like my three brothers. It’s so nice to have such welcoming and great families to stay with; it’s hard enough to come all the way out here for school, it would be even worse if our families were horrid. And then, Miles took manual driving lessons from his host mom!! (: He did pretty well, better than I would ever have done. So hopefully tomorrow we can head to the beach and into the city centre to explore some more; I think he’s ready (:

Challenging Day in Pediatrics

At St. Mary’s today, we worked with a Polish pediatrician who was an amazing doctor. We saw so many babies with so many different ailments; it was such an eye opening experience. We started off in the ICU this morning, and there were only five babies in this room. Two of the five babies had suffered severe birth asphyxia and were being monitored for brain damage and abnormal functioning and development. There was a set of boy twins who were very small that were being monitored for growth and development, and one of them had developed slight jaundice that was being treated. The last baby, a little girl, was born early for no apparent reason, so was simply being kept to make sure all was well. We then headed up to the next rooms. We saw children with everything you can imagine! It was incredible because you would never find such a child in the United States, so the exposure was good for me. You never realize how good you truly have it until you witness somebody suffering from a situation not even realistic in your life. There were SO many babies with HIV and a paired sickness, it was astounding. There were children in for HIV and TB, HIV and pneumonia, HIV and measles, or a mixture such as HIV, TB AND pneumonia, or, HIV, pneumonia AND measles! We saw some children with all of the cases listed above. We also saw children with club feet, down syndrome, HIV (even up to type three! (This is the worst and final stage before type four, or AIDS, where your CD4 count is below 200)), pneumonia, TB, measles, burns, tract infections, HIV, TB and syphilis exposure (this can be mother-to-child transfused!), distention, child abuse, neglect, pink eye (the saddest story ever; I will expand below), everything you can imagine! My heart was heavy today because barely any of the children we saw were improving or able to be released, rather quite the opposite. Many of them were struggling to fight for their lives and weren’t doing too good in the battle. It was the most horrible thing to watch the mothers of these dying children, to see them feeding and holding their child for what might be the last time. It made me want to cry, so I cannot even fathom the pain they must feel. The child with HIV, TB and pneumonia was around four, and was barely clinging to his life. His mother was there trying to feed and comfort him, but he was struggling so much—probably in anguishing pain, and you could see the same look upon his mothers face. How hard must it be to nurture your child to death? I can’t even imagine, and it’s so common here, which just breaks my heart. There was a small baby girl with HIV and pneumonia that was barely sustaining life. And there were so many babies that had been abandoned by their mother’s right after birth that were left in the hospital with no place to go. Adoption is a sticky situation in South Africa; because the living standards are far below most, many cannot reasonably add another mouth to feed. Some children had even been in the hospital for over a year still waiting to find somebody to adopt them. It broke my heart, and my family saw it coming! They all told me before I left not to come back with any children, because they could imagine me bringing home five, and my heart wanted to so badly! I knew it was going to be something I’d face down here, and I knew from my nature that I would undoubtedly want to do all that I could, but this clearly wouldn’t happen and I would get over it. But now that I have actually met and witnessed these children with nowhere to go, I’m struggling to let go of the fact that maybe somehow I could make it work and bring them all home with me! I just want to sob for them. There was one boy in particular that reeeallly made me consider it (my heart was thinking momentarily, because this clearly isn’t a reasonable option for me). He was about four months old, and the most beautiful baby I have ever seen in my life. He was about four months old and so cute and cubby, and was still in the newborn ‘baskets’! It was the strangest thing to see this big baby next to all of the tiny newborns, and so I immediately asked why he was here; he looked so out of place. The doctor explained that he was an ICU baby at birth, and was abandoned by his mother shortly after. One of the nurses fell in love with him, and couldn’t move him out to the general pediatric ward, so she kept him in to take care of him. I immediately asked if he had any prospective adoptees, and luckily, that same nurse who fell in love with him was in the process of adopting him, or I might have crumbled and had to at least look into it. My heart clearly isn’t strong enough to handle the poor situations of some children down here.

There was a little boy about the age of four that we saw later in the day that was checked into the pediatric ward that made my heart break. His mother had gotten very upset over something, had smashed his head against the wall several times, and then hit him on the top of the head with something clearly very hard and damaging. He ran into the streets of his neighborhood with blood gushing from his head and crying for somebody to help him. A neighbor finally responded and brought him straight to the hospital. He ended up needing many stitches for the huge laceration she gave him from the middle of the top of his head, all the way down to his forehead. He was still in the hospital waiting for a social worker to come and take his case. What broke my heart is when the doctor informed us that in most cases, social workers put the children back into their homes because adoption is such a difficult thing in South Africa; they usually have no choice because the child has nowhere else to go. And, because of the loving and forgiving nature of children, the little boy told the doctor that he felt comfortable returning home; I wanted to cry. There was also one more case that really touched me and made it hard to continue on working. A social worker came upon a small boy, probably about five or six months old, abandoned and left in a toilet. Nobody knew how long he had been left there, which meant there was no telling how long he had gone without food or care. At such a young age, that is completely psychologically damaging, not to mention physically and emotionally. He had developed pink eye from all of the nasty bacteria and germs in the toilet, and because it had been left untreated for quite some time, it turned into a viral case on top of bacterial. It created a ‘cover’ over his eyes, and now in the hospital being treated, he is partially blind and still has a film lining his eyeballs. He was the sweetest baby you could have asked for. How psychologically disturbed must one be to have the heart to abandon a baby that is clearly fully dependent, not to mention something created by you? I simply cannot understand such a thing, and this poor child has to live with his mothers horribly stupid actions for the rest of his life. No child deserves that ): I have such a weak spot for children. If I could take every one of them in and make everything magically okay I would do so in a heartbeat. The saddest part was that every child in this hospital had a sad story attached! In the hospitals I have worked in in Seattle, yeah it’s sad that the children are sick, but you never find them sick in the ways you find them here in South Africa, or sick for the same reasons. Obviously there are some children that are neglected or abused or that have HIV etc, but they are far and few between compared to seeing every single patient in this predicament here. I couldn’t handle working in pediatrics as a practicing physician in South Africa; my heart just simply isn’t strong enough to let go of all of the avoidable suffering that I would be fully surrounded by each day.

I am really struggling with the concept of inequality and injustice as I observe the conditions of health care here and have nothing to compare it to but the United States. Why is it okay that the places in the world with the most need receive the least? I don’t understand how it can work in such a manner. These people don’t deserve to suffer anymore than anybody else in the world, but they get served the worst predicaments while we in the United States don’t have the slightest idea about hardship. And it seems that we all believe we have things so hard, me to blame as well, but we really aren’t seeing it. We are the most well off people in the whole entire world, and as much as we are taught that and ‘know’ it to be true, we really don’t ‘know’ anything until we see it with our own eyes.

While I was home sick yesterday, Miles got the opportunity to observe in the HIV clinic at St. Mary’s. He sat in with a doctor consulting patients on medication. In South Africa because of the limited medical supplies available, only those with a CD4 count of 250 or less (stage three HIV, just barely above AIDS) receive Anti-retroviral medication. So pretty much, to be completely blunt, you only get medication when you’re about to die. Miles got to meet a man who was coming in for medication with a CD4 count of FOUR. A normal healthy adult has a CD4 count of THOUSANDS. That is unconceivable to me. Once this man left the office, the presiding doctor told Miles that he didn’t even know this man was still alive, and expected him to die within the next few days because his body has absolutely no defense mechanism left.

Yesterday was thought to be a good day, because a ‘new’ HIV medication was supposed to become available in South African hospitals, and this was great news for patients who were becoming resistant to their current treatment and had no other available options for medication. A woman came into the clinic, very sick because her strain of HIV was becoming quickly resistant to her current drug regime, looking for this new medication that will essentially save her life. Although this medication was supposed to be available, no hospital in South Africa, including St. Mary’s actually had this medication, and had to turn every one of their expecting patients down. The doctors don’t expect to see it for another four months, which will probably be too late for many people, including this unfortunate dying woman. The only thing that comes to my mind is why? Why is the world so completely unfair?

I have no capacity to understand such things, and can do not a single thing to help. My heart is aching from having to sit back and watch this take place before me. I have never felt this type of sorrow before in my life. To ease the brick off of my heart, I think it is necessary to change the subject; there is no way to make sense of it all anyhow. It is a long weekend for South Africa coming up. Friday and Monday are non-working days, so we have a four day weekend to relax and explore Durban. Miles and I were originally going to spend the weekend at a place called St. Lucia, a wetland park about three hours north of Durban. It is supposed to be absolutely beautiful with tons of things to do and see; all of the past interns have visited and loved their time spent up here. But, I think we were informed about this place a little too late, because everything is booked! We haven’t been able to find a reservation available for this weekend. We are going to try one last time tomorrow morning, and if all fails, we will stay around Durban and delve deeper into the city. I think this I what’s most likely going to happen. If my prediction is correct, we are just going to go to the Indian Ocean beach to swim and enjoy the hot weather here; it is supposed to be almost winter time, yet it’s hotter than our warmest summers! We will also explore a famous tourist street called Florida Road. It is supposed to be packed with native Zulu and African art, fun restaurants, shops and clubs, and the beach only one street away. Both of our ‘brothers’ will also be able to show us fun things to do around town to occupy our time as well. I think we will have a great weekend even if St. Lucia doesn’t work out.