Friday, June 4, 2010

Flying Solo

June 1, 2010
Today we went back to surgery after a successful day yesterday. When we got there the nurses and doctors greeted us. We were observing a shoulder dislocation manipulation. This guy had screwed up his shoulder pretty bad and it needed to be surgically. A couple of minutes into it, another doctor walked into the operating room. He was very charismatic, loud, and started cracking jokes immediately. He also wore a hearing aid so he spoke a little louder than he needed to. He was one of the consultants for ortho surgery and he was helping out Ernest. We introduced ourselves to him and he was very enthusiastic about us being there. Right off the bat he asked if one of us wanted to scrub in. Since I had the first one, Hailey got to do this one. A hour or so later it was all done. The next operation wasn’t really an operation but required sedation. This fourteen year old boy fractured had a greenbranch fracture (imagine taking a green branch and trying to bend it one direction to break it, that’s what it looks like). So obviously, this green branch doesn’t break all the way through. In order for the arm to heal properly, the doctors needed to sedate him, give the arm traction, make the fracture worse by bending in the direction of fracture, and then forcefully bend it back in the opposite direction by pressing directly on the fracture itself. Sound familiar to any of my family?? This is the exact same operation I had when I broke my radius, and I was fourteen years old too. Ernest told me I was going to do the entire thing. I got a really weird feeling inside because now I was going to find out what they did to me when I broke my arm. Actually, I was now going to do what they did to me to this kid. They briefed me on what I was going to do thirty minutes beforehand, so I was practicing on myself so I wouldn’t forget. When it was time, we knocked the kid out and Ernest held his torso. I grabbed the kid’s arm and simply just leaned back with the arm in my hand. I had all my body weight on the arm and the bones got some traction (hopefully). After that, I quickly jammed his hand upwards towards the fracture and held it with all my weight. Then I put my thumb right on the fracture sight and hyperextended the hand back down. Ernest told me to keep as much force on the hand as possible. I seriously thought I was going to break another bone or might as well rip the entire hand off. Suddenly I heard this pop and I glanced at Ernest for a look of approval or a look of terror. His face looked promising so we took an X-ray and just like that, perfect realignment. The procedure was pretty quick but thank God I was sedated. I really felt like I was flying solo throughout the whole thing. The doctors trusted me and were there if I were to screw up. I felt like this is how education should be. Both doctors are extremely praising and are willing to help along the way. I’ve got more patient interaction than ever before or ever will have for years to come. And we wonder why there are so many problems with the American medical education? As medical students, we don’t get true patient interaction until our third year of medical school, and even then you just sit in the back and shut up. Then when you’re all done and ready to practice, you’re anti social, lack patient interaction skills and overall extremely awkward. Everywhere else in the world, the medical program is combined with the university. Essentially, there is no such thing as “pre med”, just six years of education and clinical combined and patient interaction/hands on education starts at the third year. A ridiculously long, grueling, and difficult path to attaining a medical degree does not make the best doctors. It has become one of the frustrations that I’ll take back to the states. Somebody could show me how to put an IV line 300 times, but once I do it myself, it’s completely different. While on the subject, Dr. Rowe couldn’t have put it any better, “in South Africa (or pretty much anywhere else), you practice medicine. In the U.S., you practice law”. The whole purpose of medicine in the States it seems like is to cover your own ass so you don’t get slammed with some sort of ridiculous lawsuit. With that, I wonder what I’ll do when the time comes.
Anyway, back to bone crushing. After the radial reduction, the next surgery was a tibial/fibial (both leg bones) shortening and reduction. This seemed like a pretty intense surgery so I stuck around to watch it. This time this fracture was a couple years old. He was given a Hoffman exoskeleton (external pins and needle apparatus) and when they took it out, the bone failed to heal properly and crushed under pressure. The Xray was insane. His tibia (big leg bone in front) essentially slipped out of place and fell all the down to his foot. It looked absolutely terrible. Of course, he waited months to come in and get it looked it. I looked at the chart and this all happened when he jumped out of a window while running from his apartment landlord… that’s one of the weirder ones I’ve seen. Dr. Rowe and Ernest began the operation and started the incision. Right off the bat they knew this was going to be a complicated surgery. Dr. Rowe turned to me and said, “we need some man power, Miles go scrub in”. I jumped up like a little kid and ran to the scrub room and got scrubbed in. We started the surgery around one and began taking away all of the erratically growing new bone formations. I held the retractor as they were scraping away. I looked inside the leg and it looked like a total mess. There were bones overlapping, in places where they shouldn’t be, and missing where there should be bone. But they continued to hack away and we were all having a good time laughing and talking about various things. A favorite amongst South Africans—U.S. politics. I explained that my dad likes Bush and they all just burst out in laughter… I think thats happened 100% of the time. You mean to tell me nobody likes Bush outside of the U.S.? Hmm news to me : )
Time chugged along and we kept hacking away at bone. Ernest is hammer happy and loves to crush things with his large muscles. Since he’s a new ortho sugeron, Dr. Rowe needs to put him in his place sometimes. Then we had a T.I.A. moment, we were going to saw off the tibia completely using an oscillating saw. The nurse hooked it into the wall and Ernest began sawing away and then the saw died. They got the back up, then that died as well. Both air hoses had leaks in them so it made them useless. All that was left was sawing manually using a hammer and chisel. Ernest set up his chisel against the tibia and just started pounding away with the hammer as hard as he could. **remember the patient is awake!** All the sudden, we hear this very audible crack and a crunch. He had broke the bone as desired, but to hear your tibia be crushed to bits must not be easy to hear. They lifted the leg up and I saw something not human. Since they broke both leg bones, when they lifted the leg, the foot just kind of fell off and hung only by its skin. It was hanging probably four inches above the ankle so it looked completely abnormal and inhumane. I was told to hold the foot and leg at a 90 degree angle so the leg bones stick out and they could do their carpentry. I almost forgot we were working on a person, this had become a butchery experiment. A couple hours later, we were ready to put screws and plates into the newly formed tibia and fibula. We had taken out about two inches of bone so his leg was going to be permanently shorter. I had the honor of doing three screws with the drill gun along with putting it in with a screwdriver. The entire operation lasted three a half hours and I definitely felt like I helped out a lot without being a nuisance. It took a lot of force to manipulate everything back together. Plus, we all had to wear really heavy lead filled vests so we didn’t get penetrated by the x-rays. When we took it all off, we were all sweating through our scrubs. I had no idea it was that grueling. Surgeons always talk about how time seems to fly by and you feel nothing until you’re done, and it’s true. I had no idea I was sweating that much and all the back pain came after I was done. So another surgery down, assisted in a tib/fib shortening and reduction. Pretty cool I think! As of right now, I’ve really come to love this week in surgery. I have learned so much from the doctors and have received so much opportunity.
Final Countdown: 4 days

Doctors of Carpentry

May 31st, 2010
As winter progresses here in South Africa, so does my inability to wake up in the morning. It is pitch dark whenever I wake up and it doesn’t get light until I get to work. Also, for those who think Africa is just one big giant sun-fried continent, that is so far from the truth. The African sun is not what kicked my ass (well maybe in Durban, but this is like comparing Costa Rica to Finland), it was the African cold! There is no central heating in any of the houses and as a result, the houses are generally freezing. My house is full of tile and hardwood, and my room feels the coldest. For the past week or two, I wear socks, BOTH pairs of pajamas, a thermal shirt, my black sweatshirt with my hood on, and a beanie to bed. Yet, I’m still cold. Also, my family’s hot water isn’t the greatest so I have learned to take cold showers…a lot. Additionally, as the days get shorter, the calls for prayer start later. Now I didn’t think these existed, and then I went to Dubai. Then I thought it only exists in the extremely Muslim countries. But these occur throughout South Africa as well. Muslims pray five times a day for twenty minute each session, and they like the whole world to be aware of it. There are speakers at the mosque about a mile and a half way in a town called Gatesville (same town as the Gatsby). So every morning at around 6:15 I am “gently” wakened up to some man screaming to Allah. I can only imagine how loud they are at the mosque. In the summer, they start around 5:20AM. I didn’t realize how strong of a Muslim community I lived in. Our driver, Uncle, is Muslim as well. The mall across the street is strictly Halaal, which means no pig products are sold. At Mugg and Bean, bacon is called macon…and to be honest I have no idea what macon is, so I don’t order it.
We got picked up at the usual time without Lauren. It was strange not having that third person in the car. We got to Jooste and went about our business. I feel so ready to come home so it becomes difficult to keep my head in the game here. The motivation is beginning to fall and the daydreaming continues to increase. For our final week, Hailey and I decided to challenge the surgery department. After our disastrous beginning in Durban, we had been apprehensive to go back to the surgery department. We put on our scrubs and had a choice to go into the orthopaedic theatre or into the general theatre. I’ve always wanted to see how barbaric carpentry works, so I went into the orthopaedic theatre. When I walked in, I saw the surgeon at work doing a tendon repair on a hand. She had been stabbed seventeen times by her ex boyfriend because he didn’t want to let go of her. It was sad because I could tell which wounds were defensive and which ones were inflicted unknowingly (yay for watching years of crime shows). Thankfully, I didn’t get nauseous at all. I wasn’t expecting it though because I really have an interest in it and anything beats perianal abscess drainages (there was three of those happening back to back in the other room). He introduced himself as Ernest and he was wrapping up the surgery. He took off his scrub gown and WOW what was underneath was insane. This man was built like a train. He had huge arms, shoulders, back, chest…everything. I guess you really need that build for this occupation. We watched another surgery after the tendon repair and I was really enjoying what I was seeing. After he wrapped the next one up, he turned to me and asked, “are you keen on scrubbing in on the next surgery?” Hell yes!! But then I retracted and asked what that consists of and he says just holding things and helping out.
So I was hustled into the scrub room and was taught how to properly scrub in. I walked into the operating room, hands in the air in order to keep sterile and was dressed by a nurse into a scrub gown. She asked what size gloves I am and I had no idea. I compared with Ernest and I actually dwarfed his hands. Turns out I’m the biggest size of gloves you can get, sad. After I was all gowned up, I approached the table careful not to touch anything non sterile. My first operation would be a complete ankle reconstruction filled with plates and screws. The lady fractured her foot 10 weeks ago and is just now coming in (nothing out of the ordinary). Her ankle had essentially fallen apart and had shifted to the left. Also since it’s an old fracture, tons of new bone grew erratically. We had to take away all of the new bone and then reposition the fibula in an attempt to shift the ankle back into place. We opened her up and it was quite a rush. It was so amazing because I looked around and it was just Ernest and I on the table and a couple scrub nurses helping us when we needed it. I was told to hold the retractor and put a couple clamps down. Things were running somewhat smoothly (it had been difficult to remove all of the improperly grown new bone) and we began to get the plate ready. Ernest put the plate against the fibula and asked for the drill gun. The nurse pulled out this giant drill gun hooked to an air compressor. With help from the X-rays being taken every minute or so, he began drilling into the ladies fibula. He did the first and last screws with ease. After he drilled, he inserts a depth gauge to see what size screw needs to be inserted manually with a screwdriver. Right as he finished his second screw, he looks at me and says, “your turn” and hands me the drill gun. I don’t exactly remember what went through my head; I think it went a little like “no way. YES. No I can’t. Oh my God it’s a human leg. Now is my time” so I said yea, sure. He put the drill guide into place for me and said to drill away. I put the bone-residue covered drill bit into the guide until it clicked against the bone. Then I realized this city boy has never really used a drill gun before. I put some elbow grease into it and drilled into the damn thing. Midway into the drill I realized he didn’t tell me when to stop, but I remember hearing how it went. I pierced the fibula, which took some force, and the drill went straight through the marrow like butter and then hit the other side. When I felt the drill exit the other side I stopped immediately. I put the depth gauge in, took the X ray and it was in the right spot. The proper measurement for the screw was between 14-16mm. My measurement: 14mm : ) and I repeated this procedure three times and got 14 each time. After each drill I was given the screwdriver and screwed the screw in. Under all those blaring surgery lights, I broke a sweat putting those screws in. It takes a lot more effort than I thought! I guess when you’re trying to bore a screw through some bone; it does take some intense effort. Now I know how Ernest got his massive arms.
This truly felt like a pinnacle moment in my experience here in South Africa. I couldn’t believe I scrubbed in as a first assist for an ankle reconstruction and was able to drill holes into some ladies leg. It felt so good to do it (not in a sadistic way) but I thoroughly enjoyed the entire surgery and think orthopaedics is an awesome field. Here is the craziest part of it all; the entire time this operation happened she was AWAKE and alert! She was given an epidural before the surgery began so she couldn’t really feel anything. But I’m pretty sure she can hear a drill going into her leg. Oh well, welcome to Jooste.

12 course meal with UFC fighters

May 30th, 2010
Sunday morning Gregg picked us up, our friend who owns an adventure tour company. We were going to west coast where they are known for their seafood. When he picked me up, I saw this huge bus out front with about 15 of his friends piled in. I had no idea who any of them were so it took a while to get to know everybody. Two hours later we pulled up to some beachfront that was covered with netting and buoys. We walked through this little tunnel and came out into this open area filled with grills, brick ovens, and benches sprawled throughout. This was all on the beachfront and the people were grilling freshly caught fish on an open fire. We sat down and got informed what we were getting ourselves into, a twelve-course seafood meal! He said the meals come out throughout the day and it is a self-serve method. They also are known for freshly baked breads. I could see bread being put into the brick oven to be baked. The finished result was incredible looking. We began our first course and it was just some sort of fish, I can’t remember the exact kind. All I remember was snoek (fish only found in Cape Town), Hake, Angelfish, and something with the word “stump”. When I dished myself a piece of fish with my friends, I was wondering where the utensils were. I must have looked confused because some man came over and said the utensils were right there in front of me. I looked down and into this bucket and saw the utensils. How fitting, they were emptied mussel shells. Cheap beer and wine flowed everywhere and the environment was very relaxing. Again, I’d love to take my friends and family someday. This city continues to amaze me with the amounts of activities to do. You don’t even have to be a tourist and you’ll still be able to go here whenever and have a good time. As the day progressed I noticed a lot of the conversation was about beating people up. Most of the friends were comparing one to another saying who could take on who. I asked why everyone is having this fascination with beating each other and got the strangest answer, “Oh, we’re all UFC fighters”. So I was having a 12-course seafood meal with 15 UFC fighters. They are all friends and train 5 days a week, 4 hours a day. At that point, these people became instantly cooler yet instantly weirder at the same time. I would have never thought any of them were UFC fighters but I found it kind of cool that the cute blonde girl next to me was a ferocious cage fighter. At the end of the meal, they started to make some coffee the old school way. They threw everything into a giant cast iron pot and let the coffee percolate over the fire. Towards the end they take one of the steaming logs from the fire and throw it into the coffee pot. In the end, I got the best coffee I’ve ever had… done over the fire with a smoky chicory kick.
That night I realized where I was at in my trip, the end. I was going into my final week and couldn’t believe this was all coming to an end. I was looking through my pictures on my laptop and did the whole beginning to end thing. I couldn’t believe over two and a half months ago, I was roadtripping with Jayson (who I miss terribly) down to California. Then came the Dubai pictures, I can’t believe I actually traveled there! By myself! That was the just the beginning of this journey. The pictures of my host family in Durban made me smile, and they seem like such a memory already. Time has truly flown by in some regards, but I can appreciate its duration through all the photos. Lauren left on Saturday and it was so strange because I felt like I was saying goodbye to a friend who came to visit me at home. The reality is that I will be in her position 7 days later. I think I’m ready to come home but I know will be an adjustment.
Oh ya, and another crazy revelation, I graduate from University of Washington in a week and a half. That was weird to type.

Monday, May 31, 2010

Ortho, Winelands, Table Mountain

This week at work, we went into orthopaedics. This is a field that I haven’t had much exposure to and have had some interest. Tuesday was fun because the doctor gave me the X-rays, the charts, and the patients to myself in the room for about 5 minutes. He told me to look at the X-rays and see if I can determine where the fracture/break was, what type it was, and to find the history on the patient (how he/she is doing, how the break happened, how long he/she has had the break). It was awesome to get some one on one patient time and to see if I actually knew how to read an x-ray correctly. Doctor Chivas (yes, like the whiskey) was more than willing to help me out whenever I had no idea what was going on. A lot of patients were victim of assaults, gunshot wounds, and just simple falls. What was scary was when this obese woman came in complaining of severe ankle pain. She fell in 1982 and since then her ankle has become increasingly difficult to walk on. I looked at her ankle and it looked incredibly swollen. The X-ray had just come in from radiology so I took a look at it and with my rookie eyes I knew something was not right. Doctor Chivas came in and his eyes widened. He explained that her ankle has essentially been completely condensed and crushed, leaving no ankle. It was her leg bones attached directly to her foot bones. This most likely happened because her ankle never healed correctly in 1982 and now her walking and weight crushed her anklebone down to nothing. At this point, there’s nothing we could do, except one very permanent option. The doctor offered a very expensive, painful, and major operation. Essentially, we could fuse the ankle together permanently. They would install plates connecting her foot bones to her leg bones. Her ankle would be permanently immobilized and she would be too for 3-4 months. She also has a couple kids and takes care of multiple grandkids. He tried to explain this to her pretty quickly but to me, I don’t think she really understood. But she said “my ankle hurts, so I guess I’ll do it.” I was shocked… I felt like she truly didn’t understand what Dr. Chivas was saying and thinks that it’s going to fix the problem. Oh ya and the pre-op meetings take about 3 minutes and happen right after you make the decision. It’s so much information to take in I’m sure one could lose track of everything.
After that, we went into the casting room to see how things were going on in there. We met Dr. Smith, a 75 year old retired doctor who came out of retirement just to help out the hospital while the other doctor was on leave. He was such a great guy and really knew what he was doing. These doctors here can manipulate almost any broken bone back into place. Again, South African doctors are known for their ability to see, feel, hear, and then treat and are spot on a lot of the time. We helped reduce some foot fractures and put some plasters on people’s limbs. One lady came in screaming on a wheelchair, she had fallen and had one of the nastiest fractures I’ve ever seen. Who knows how she fell but her upper arm bone had been absolutely dislocated into her chest leaving her ball joint literally floating down her arm somewhere. Dr. Smith put the X ray and started laughing, “Lady there is no adjustment, no plaster, and nothing I can do to help with this ridiculous looking fracture. Ow that looks painful.” But he did suggest a plaster around her arm to make the pain go away somewhat. That would require her lifting her arm so that they could put the plaster around it. My God she screamed like hell. All I could do was tell her its going to be ok and let out a laugh every twenty seconds. She was cussing in Afrikaans and in English and apologizing after every word. It was funny and everybody was somewhat laughing too. After she was plastered, she was laughing about the whole thing as well. It was lunch around then so we headed upstairs and had some lunch. I started feeling dizzy and didn’t feel too hungry. Then I became nauseous. Wednesday would be my last day for that week… my great health streak would come to an end. I got some sort of stomach bug for the rest of the week that kept me in bed (or in the bathroom) for most of the nights. I had plenty of sleepless night and felt pretty miserable. My appetite has been pretty much zapped as well. I tried to push through as much as I could. We hired a car later that day since we have so much to do. I didn’t go to work Thursday and spent all day in bed just trying to get better.
The girls got off early from work on Friday and picked me up. Since our time was limited we had to cross some things off our list. I was actually hungry for the first time and fulfilled one of our “must-do’s”: buy a Gatsby. Now, this is a serious meal and not for the faint of heart. This is a health freak’s nightmare and an artery clogger. We went to the Golden Dish, home of the Gatsby, in Gatesville. It was a pretty sketchy area of town, of course only five minutes from our house : ). We got more than a few obvious stares but I was determined to try this thing. We ordered a full house Gatsby and it only took about five mintues or so to make. So now to describe this monstrosity. We initially asked how big is regular, the lady help up this 2 foot long log. After seeing that, we decided to share a mini size. When we got it, it was easily two pounds and the size of a small child. Now for the Gatsby description, it’s a sandwich jam packed with pretty much anything. Ours had lettuce, some sort of sauce, steak, fried eggs, French fries, and cheese…and probably some other stuff they decided to throw in there. My appetite suddenly came back with a vengeance and I ate more than three quarters of the whole thing.
I planned on staying in that night and hoped I would get better by the next day. Justin (my host brother) was home as well and asked what I was doing. I said not too much and ten minutes later we were on our way to get Cape Town’s best milkshake. I thought it would be a good idea to get some liquid nutrition inside of me. After we got the milkshakes, we drove around the area and ended up driving by Galaxy, South Africa’s oldest nightclub. Before I knew it, we were going to go inside and check it out. I wasn’t feeling too up for it but I just wanted to power through and hang out with Justin as well since we don’t too much. We picked up his friend and went from there. I remember walking in the club and feeling completely out of place but somewhat welcomed at the same time. I got some pretty intense stares from people in the club but was also welcomed by some of the people he knew in there. Maybe because I was one of the five white people in there? I think so. The whole night I people watched and just talked with some ladies who immediately knew I was not interested. At least somebody knows now : ). The grossest part of the nightclub was definitely the hottub they had on the deck. Who knows what goes down in there or what’s festering in the water. It was a fun night overall and I’m glad I got to spend time with Justin.
After getting back around 3:45AM, I had to wake up at 8 AM on Saturday so we could do the winelands. It’s very difficult to wake up early in the morning to go drink alcohol after having some the night before and not feeling too well either way. This was one thing I wanted to do since I’ve been here so I refused to cancel this trip. The winelands are only 20 minutes or so outside the city making it very convenient to get there. Our first stop was J.C. LaRoux, Hailey’s favorite champagne here in SA. Stellenbosch (wine town) is very picturesque, with grapes growing all along the countryside with Table Mountain towering above them. SA’s speciailty is red wine, btu they also have some great whites and sparkling wines. We sat down and started trying all different types of sparkling wines. I learned how to open a bottle of champagne with a sword and plan on doing that upon my arrival in the States (with a butter knife or something though). I tried to appreciate all the flavors they told us about in the sparkling wines, but I’m just not the biggest sparkling wine/champagne fan. After J.C., we headed to Waterford. This estate was beautiful and was my favorite of the whole trip. It had a very Mediterranean feel to it and were famous for their chocolate and wine pairings. Tastings are relatively cheap here and the quality is amazing. We went ahead with the chocolate and wine tasting and we were presented with three wines on top of this engraved wooden block with 3 pieces of different chocolate. There were two red wines and a dessert wine. The first chocolate literally had flowers in it, the second was sea salt with a dark chocolate, and the third one was too gross to even identify. The red wines were very good, the dessert wine was disgusting…too sweet for me. I purchased a summer wine I had tasted before the chocolate pairings, and walked away a happy and boozy customer.
From Stellenbosch, we drove to Franschoek for some lunch and well..more wine. The third winery was all about the view, the wine was a little sub par but nevertheless still good. All the superb bottles of wine at most of the estates were about $8.00. I wanted to stock up but I definitely didn’t want to go overboard. Charles Shaw/ two buck chuck won’t ever taste the same after this experience… At the end of the day, I could not even think about having another glass of wine. I probably smelt like mom’s kisses but hey, its all part of the experience.
Sunday morning began with a generally sunny day. There were some clouds in the air and not too much wind. It was an opportunity to do Table Mountain. We drove to the foot of the mountain and saw that the cable car was open. However, Lauren and I decided to hike up the mountain and take the cable car down. Little did we know what we were about to get ourselves into. The beginning of the hike was pretty brutal, straight uphill and a bunch of boulders put together that we had to climb up. We thought it had to get a little better from there. But that never happened, in fact it only got worse. We literally hiked above the clouds, straight uphill on rocky, unstable, and uneven rocks. It took us about two hours to get to the very top which is pretty good timing. My legs were shaking and I was completely out of breath. I drank my entire water bottle and was planning on filling it up once I got to the top. The view from the top was amazing, even though clouds started rolling in. The wind was picking up as well making the clouds fly over the mountain. I found this little rock projection with a great view of the ocean. After that bungee, I thought scaling a little rock projection that has a cliff on all sides would be a walk in the park. Of course once I got to the tip, the wind started blowing like crazy. For a second I thought I was going to be blown off and die down Table Mountain. After getting my daily adrenaline fix, we headed to the cable car, café, and bathrooms. As luck would have it, the cable car closes due to the wind unexpectedly. Now were trapped up Table Mountain with no desire to climb back down. I hadn’t eaten anything in a while plus I needed to refill my water bottle so we headed to the café for some food. Except there was a problem, it was closed. Why the hell is this place closed? I was STARVING after that grueling two hour hike. It felt like nobody else was up there with us. Lauren then had to go pee really bad, we headed down the steps to the restroom. LOCKED!! So now we are stranded on top of some mountain, with a closed cable car, a closed café so we couldn’t refill our water bottles, and closed restrooms for one god awful reason or another. There were no phone numbers, no employees, NOTHING to even give us a clue as to when the cable car would reopen. Now I was getting frustrated, thirsty, and hungry…not a good combination. Abiding to the laws of physics, what goes up must come down… and that applied to us. Jumping off the side of the mountain sounded appealing but I at least wanted lunch so we went against our will and began the long and painful decent. We thought maybe going down would be easier? WRONG again! Going down was much worse than going up. Since the surfaces are so uneven and steep at points, this was a huge strain on the knees. It hurt after a while and when you see how much you have left (~2500 feet all downhill/uphill), it can get depressing. I slipped a few times since my legs started to give out. I don’t think we really stopped, we were so determined to get down. Whenever we stopped, our legs would begin to shake and get weaker. I lost track of time but eventually we reached the bottom. Now to quote everybody else’s foreign blog entries (Paola, Bryan), that was the hardest hike I have ever done in my life. No picture can capture the sheer height, steepness, or difficulty this hike contained. I literally climbed a damn mountain, and coming from the 12 year old kid who complained of the concept of walking uphill for no reason, it was a big accomplishment. I did a 12 hour hike one time, but it was a pretty easy hike. I scaled the side of the World Cup stadium in Durban. Hell they were both nice strolls. Those two hours uphill and then back downhill kicked my ass. I was sore for five days after and avoided stairs and all things inclined during that time. I felt pretty accomplished a couple hours after we were done (I was still bitter over the closed bathrooms and water refilling station).

Monday, May 24, 2010

Adrenaline WeekEND continued-Garden Route

Soon enough, the weekend rolled around and it was to be an exciting one. We had the opportunity to drive along the Garden Route with our program coordinator and medical director, Marion and Avril. The day started with an alarm going off at 4:30AM. Somehow, I stumbled into the shower and did my thing. As I was drying off, I put my finger over my ear lobe and noticed something was missing. My earring must have fallen off I thought but it was really sore. I felt the backing of my earring still in my ear and then I got worried. Upon closer inspection, the ear lobe was bleeding and swollen. I probed at it some more and lucky for me my earring was still in….inside my ear. Somehow the stud went inside my ear while I was sleeping. Feeling pretty shocked, I phoned Avril and told her the situation. She told me not to worry and we’ll figure it out. Sure enough, I got picked up at 5AM and drove 30 minutes to Marion’s house. At her house, she busted out her medical kit out the back of her car and she started inspecting my ear. Without warning she yanked on the backing that was in still lodged in the back and pulled out the entire thing. Yes, it did hurt… but it felt good to be out. Finally, we were on our way to our 3 day adventure.
The drive was pretty (after 730AM that is, it was dark before then). I was also falling asleep intermittingly. We stopped for breakfast at the Country Pumpkin honestly in the middle of nowhere. The breakfast was delicious of course. A couple hours later we arrived at the Cango Caves. We were able to climb through caves in a ninety minute tour. Some of the caves had super tight squeezes. The worst one was definitely where we had to crouch and walk for like a minute straight. Other tunnels included the tunnel of love where we had to walk side by side, devil’s chimney (I thought it was the best one, consisted of climbing up this really tight tunnel 5 meters high), and the letter box where we had to slide through it on our stomachs. After climbing out of there sweaty and smelling like hot cave, we headed to an ostrich farm (duh what’d you expect?). As we began driving, we noticed the mass amounts of ostriches in this town called Oudtshoorn. It soon became an ostrich extravaganza. EVERYTHING in this place was ostrich themed… the restaurants, cleaning supplies, lifestyle, meat, and many more. Eventually, we pulled into this place and sat in on an ostrich lecture…hmm. The lecturer held up a pellet and told me since I’m the only guy that I have to kiss the ostrich. Eff are you kidding?! These things are gigantic and dumb as screws. I really had no desire to do this but I don’t think I had a choice. We proceeded into the ostrich holding area and he shoved me into the pen and told me to put the pellets in my mouth and close my eyes. Betsy then bolted over to me and nipped the pellets out of my mouth. Like the dumb bird that she is, she missed twice and left marks on my face. It was something bizarre and slightly unmemorable. Let’s just say it was a one time only thing. Since Hailey didn’t feed or kiss the ostrich, the guide demanded that she ride first on the ostrich. How they wrangled the ostrich was another thing. First off, ostriches are absolutely retarded. If you look at one you can see how tiny their head is, inside their head must be a brain… putting it together, ostriches have brains the size of a peanut. Anyway, the wranglers go out into this ostrich confinement and they start going crazy and running. Given that they’re all dumb as hell, all you have to do it put a blindfold around the ostriches head and it thinks they’re all alone and nobody is around them. Once they did that, the ostrich stopped running around and panicking. They guided it back to this horizontal A-frame looking thing and Hailey had to straddle the ostrich reluctantly. They lifted the wings up and she sat on top of it and began to scream. Suddenly the removed the blindfold, the ostrich backed up, and they just threw her into the confinement and the ostrich ran like crazy. She lasted only a little bit but it was the funniest thing I’ve seen in a while. She ran over to Marion and Avril and cried in their arms in sheer terror.
I was up next, and soon we were realizing we were the only ones doing it out of the entire group (there were some Dutch and Italians with us). Again, I straddled this ugly monstrosity and it just backed up like it was nobodys business and took off. The video is pretty funny and is also on Facebook for everybodys enjoyment. The guy shaked my hand afterwards and told me I did a really good job. I guess I lasted a long time? Or maybe owning an ostrich farm is my true calling. After that we drove a long time until we hit out hotel in the town of Wilderness. Creative huh? We went out to dinner later that night and had a good time with Marion and Avril. When we came back, the three of us opened up a bottle of J.C. La Roux champagne and partied in the room.
The next morning, none of our alarms went off for some reason, so we woke up and had to eat breakfast in five minutes before taking off. During those five minutes, we received some sad news. Avril received a call when we got back from dinner to let her know that her mom has just passed away. It was a pretty devastating blow but she had been suffering for quite some time now. It was all a matter of time before it happened but it was sad that it happened that day. Avril insisted that we continue with the trip after we offered to go home early. The whole day was to be filled with crazy things to do but it was definitely bittersweet. The first stop was ziplining. We were able to zipline through some pretty tall canopies. I’ve always wanted to try it, so it was awesome that I got the opportunity to do that. We got lunch after we returned and we had to take it to go because of time constraints. As we started eating our lunch we asked what was next. Marion turned around and casually said “bungee time”. We all looked at each other, then at our lunches, and then quickly put it away and began to panic. I had been dreading this moment since even before I came to South Africa. Thirty minutes later, we saw the bridge that we had seen online and my stomach felt like it dropped 216 meters. We pulled into the place and had to rush to get registered because this giant Indian tour bus pulled right behind us. We were harnessed up and then were told to wait for 30 minutes or so. I walked over to the viewing platform across the way from the bridge and looked down. It was HUGE. No picture, no video, or anything can really put into perspective how absolutely gigantic this drop is. A bungee-er was about to jump (or be thrown) and I decided to watch it. Big mistake. I could barely even watch it since I began to put myself in that body flailing around. The person dropped so far it felt like it never ended. A canyon surrounded the bridge with a stream leading out to the ocean down below.

Eventually, it was time to walk out to the bridge. Since the bungee platforms are slightly below the bridge, they needed to construct a tunnel to get us over there. This walkway had a hollow grated bottom… so as we were walking we could see what was down below. It was already terrifying and only making the pre-experience worse. Finally we got to the bridge bungee platform and the music was playing which eased my nerves a little bit. They instructed us how everything works. The order we signed up for was not necessarily the order we will be jumping. It all depended on what cable was attached at the time, so it went according to weight. The guy held up the clipboard to his face and was like “hmm… ok let’s have our first jumper be…Miles”. Out of our group of twenty, I get to go first. Lovely. Going first on these thing carries a big role of making sure you don’t screw up. I started to get strapped up…which took a whopping 20 seconds because it consisted of simply strapping on a little booty. Phew, glad this nifty booty that’s been used thousands of times is going to keep me from falling 708 feet to my death. I remember looking behind me and seeing everybody’s faces. Most of them had their hand over their mouth. Hailey and Lauren were genuinely concerned and Hailey even began to get tears in her eyes. Soon enough I stood up and the crowd started cheering for me. I was helped/hobbled over to the platform where I had to stand at the very edge of the bridge with my toes dangling off the edge! That was by far the scariest part of the entire process. I gave a wave to Marion and Avril who were hopefully watching from the viewing platform at one side of the canyon. If not I just waved to nobody. The people behind me started to cheer, which was nice and encouraging. The wind would gust at times and when you’re standing at the edge of the bridge you either want to jump prematurely or run back to safety. But they spreaded my arms out like a damn eagle and before I knew it, “5 4 3 2 1 bungee!” and all I remembered from our mini orientation was to jump out… so I did just that… I jumped like a crazy man. I honestly didn’t know what was going on at first. I remember it being about 7 to 8 seconds of flat free fall. That feeling of your stomach in your throat and feeling of self-implosion. I flung back up and down again which was another huge drop. That hang time between the first and second drop is pretty awkward and long. At that point, I realized what was going on… I had just jumped off a 708 foot bridge attached to a stupid cable that I put my life on the line for. But instead of being mad, I became high or something. A feeling of complete euphoria came over me and I just relaxed and enjoyed all that this jump had to offer. I was completely alone bobbing around in this canyon, I remember hearing my echo and thinking how cool this really all was. After having that little moment, I realized my head wanted to explode since I had been dangling there for what felt like forever. My eyes felt like they were bugging out of my head and I’m sure I just looked like I had been asphyxiated. It seemed like an eternity before this guy came down and began pulling me back up. Eventually I was getting pulled back to the bridge and right as I was pulled up, Lauren had jumped off (she was the next person on the other cable. Hailey was 15th or something). Apparently Lauren had grabbed onto the guy during the first countdown with a death grip. This girl managed to jump even with a fear of heights. I was placed on the platform and the guys played a trick on me and almost threw me off again. When I was released from my straps everyone came up to me and congratulated me and asked how it was. They also told me I had red dots above my eyes and also that they were bloodshot. I saw a reflection in a metal bar and saw that I got patikeye which are essentially blood vessels that exploded. You can see them in autopsies when people have been strangled to death. But I guess I can get them while bungee jumping. Nobody else got them so I have no idea what the hell was up with that. Hailey continued to have tears in her eyes and apparently screamed when I jumped. I couldn’t believe I actually did that jump, after all the nauseating YouTube videos I watched… I finally did it. Overall, I think it was a once in a lifetime experience. Even though it was a crazy feeling, once is just fine :)
After that exhilarating experience, it felt like everything else to follow would be just so calm. But I think that would be fine considering that was enough adrenaline to last me for a while. Up next was the Knysna Elephant Park. When we got there we sat in on a little elephant movie and then hopped in a tractor and was lead to the elephants. Right as the truck pulled up, the elephants immediately knew what was going to happen. They rushed over and seemed very happy. They all got behind the little post where they belonged and we were able to feed them. Of course you get your selfish elephants that try and steal every piece of food that’s put out. I tried to help the less fortunate ones but those trunks can ambush your bucket in no time. Also I had a runaway elephant reach from behind and steal some fruit. It was quite scary to turn around to this massive thing reaching in your bucket. After that we were able to mingle with the elephants like they’re our buddies. They didn’t mind the company at all and were able to be touched by us. Definitely not everyday you’re able to just hang out with the elephants and touch them...or hang on their tusks. The day didn’t end there, after that we drove and went on a sunset cruise around the bay. We were all able to catch up on the day and see how everyone was doing. It had been a long and rushed day. Avril was in good spirits despite her loss this morning.

Adrenaline Week-Casualty Department

This week in the gangyard, we were going to be put in the forefront of the action, the casualty department. Here we get the emergencies, walk-ins, referrals, and the infamous wheelbarrow dumps. Since Jooste caters to most of the townships, not many people have cars and transportation. If somebody was to get hurt, they put the victim in a wheelbarrow and rush him or her to Jooste and literally just dump him or her there and hope that somebody will help them. I was very nervous to work in this department at first. I was actually dreading it. Given my previous experiences in Durban, I didn’t know if I could see all the stuff all over again. When we walked in casualty, sure enough we were met with chaos. The doctors were all over the place, but eventually took the time to introduce themselves. They are always on their toes, know how to act resourcefully, and most importantly remain calm. The sisters were fantastic, probably the best I’ve worked with since my time here in SA. They were all so friendly, so enthusiastic, and quick on their feet. Within the first hour, somebody died from a stab wound to the pelvis. Wow that was quick. The environment of the casualty department is very quick and dirty. They have an extremely high turnover rate, crushing any U.S. turnover rates. When patients come in, they are triaged, and hopefully sent to one of the wards after coming through casualty. We basically just followed some doctors around and met two 5th year medical students, Jon and Kamlin. They were awesome guys and were a great source of information. Luckily, they were rotating in casualty that week so we would stick with them the rest of the time.
Later on that day, a guy came in with severe shortness of breath. He was panting pretty hard and the x ray showed he pretty much had one lung left. He had full blown pneumonia that had gone untreated for weeks. He was put in the resus (resuscitation) room where we tried to control his breathing. Nothing was working so we put a tube in his throat so we could breath for him. I could tell he was in a lot of pain and panicking. As he was getting ready to get tubed, the doctor told him he would be knocked out for 2 days and that his wife already knows about it and said it was fine. He died later on that night due to too much fluid in his lungs. In one day, there were already two deaths in the unit. Needless to say it was quite an action filled day. Strange thing is… I wanted more.
Wednesday came around and the casualty ward felt like a mini psych ward. Due to the massive tik (crystal meth…is this where Tik Tok came from? Nice going Ke$ha) problem here in Cape Town, we get a lot of psychosis. It is not uncommon for an 8 year old to become addicted to meth here in Cape Town. It’s readily available in schools and around the townships. Overdoses are also pretty common and we saw our fair share of them here in casualty. Most of them are suicide attempts by the younger crowd. Eventually, they just get charcoaled (real charcoal that’s shoved down a nasogastic tube into the stomach in order to bind all the toxins so they don’t get any further…gross stuff), vomit, and are released. One of the sad cases was this 19 year old girl who OD’d on heroin, meth, and cocaine. She screwed up her body so bad that now she is mute. She just had a child a couple weeks ago and obviously its in the wrong household. The doctors were able to talk about taking the child out of the household and put into foster care right in front of the mom. All she could do was look around with this clueless smile on her face. After seeing her, I kept hearing this noise that sounded like MAAAA!! It was getting quite annoying. Eventually I found out who it was. It was this woman in her 30’s who overdosed on insulin. Now overdosing on insulin highly fatal especially if you’re not a diabetic like she was. We have no idea why she decided to take insulin, maybe she thought it was a different drug. What happened though was essentially all of her glucose in her body was depleted. When the brain has no sugar, it begins to die. Somehow, she took just the right amount of insulin to survive. Now, her brain is just a piece of matter that continues to deteriorate. She has essentially reverted back to a 4 year old and has no idea who she is, where she is, or what she’s doing. Every 2 minutes or so she gets up and tries to escape the ER. Security then has to go retrieve her and bring her back in. It is then where she starts screaming and sometimes falls on the floor. She has to wear a diaper because she has no bodily function anymore. It’s sad to see it happen all the time, but why she remains in casualty to this day is beyond me.
As the week persisted, my interest for emergency medicine continued to shock me. A doctor asked me to put up a line and draw some blood. Since I had no idea how to do that, I asked her if she could teach me. Thankfully, she was very willing to do so. I was expecting just to watch her do it and then maybe I’ll help collect the blood. She handed me the needle was said to get comfortable. She pointed towards a vein in the wrist and told me it’s all about feel. What the hell does that mean? I looked at her one more time for assurance and said it’ll be just fine. I took the needle and went straight for the point of convergence. Sure enough, she was right, it’s all about feel. I could feel the needle enter the vein and I was able to set up the entire line and draw some blood. Yay for accomplishments right? Back in the resus room, there was a guy with badly beaten appendages. He had been a victim of a community assault. In the townships, when rumor goes around that somebody has committed something bad in the community, they have a “community task force” that takes crime into their own hands and retaliate against the suspect. They use long, elastic, and plastic white batons to beat the person but never to death. Since they are elastic, the plastic turns into a very hard whip. A group of 6 people or more usually ambushes the person. This guy was beaten pretty badly and he couldn’t move most of his body.
I remember taking a moment and looking around the room, there were people crawling on the floor, crying, bleeding, coughing, and just had the vibe of a miserable place to be. There were dead people being wheeled in and put into an empty patient “room” that has been partially curtained off. That environment never goes away but it also rewarding to know that you have saved someone’s life long enough to get him or her to a specialist. I know now coming away from that week that emergency medicine was that hidden passion I didn’t know I had. I remember challenging myself before I came to South Africa to go to a department that I really had no previous interest in and see if my perception changes. Fortunately, I can say I have completed that goal.

Cape Point Drive

After our accomplishing moment, we hiked back to our car. The weather was getting pretty hot at this point but we loved it. The entire workweek was rainy, windy, and cold so this was a well needed change on such an ideal day. We wanted to drive to this beach we saw from Cape Point. When we arrived there, the dreaded baboons greeted us. We were scared to get out of the car since they can hop in the car and steal all you have. Some guy with a bat was chasing them away so they eventually left the area. However they came back not too much long after this time with the whole damn family. We couldn’t even go down to the beach we wanted to go on because they were blocking the pathway. The baboons started hopping on some cars and the little ones found some fun out of a surfboard that was on top of a car. They played see-saw and jumped on one side to bounce the other side up. These people tried to get into their car but the baboons quickly came to the driver side and swiped their hands from the handle and tried to open it. Luckily it was still locked. It was amazing how quick and agile these baboons are. They are also not afraid to come near people (obviously). Finally the hero with the cut off jean shorts came around the corner and scared them off with his bat. The baboons just transferred onto another car and the head honcho baboon was eyeing us. I took one step towards the car and it lunged on top of my car and tried to open the car door. It eyed me the entire time and followed my every move. I tried using my car alarm but it didn’t even make him flinch. Finally, the cut off jean hero came to save the day again and made some gorilla noise with the bat in his hand and scared the entire family off in time for us to hop in the car and take off. So, my advice to people visiting Cape Point, the baboons are REAL.
We left the reserve laughing in complete shock that a baboon family almost shanked us. We continued to drive, now on the Atlantic side. We heard about this “local” beach called Noordhoek. We had lunch there and then headed to the beach. The beach was very nice, and seemed pretty untouched, and the sand was white and soft. We saw this cool picture opportunity on top of these rocks that were accessible when the tide receded. Eventually, we all made it on there and began taking some pictures and were waiting to hop on the next rock. Sad thing is that the tide never receded again. We started noticing our pathway of opportunity was never reappearing. The water level on the rock started to rise and it became very apparent that we were getting trapped. Waves started crashing into the rocks and the situation became scary for sometime. Nobody touches the Atlantic side, the water is ice cold even in the summer. Somehow, we managed to maneuver our way to the beach with minimal damage.
The sun was setting and we needed to get to Chapman’s Peak before sundown. We saw a sign for a winery and decided to pull in and grab a bottle of wine (with some free tasters of course : ) ). We continued with wine bottle in hand and made our way to the peak. This part of the drive is rated the most scenic drive in the world, and they were not exaggerating. We were so close to the cliffs and there were so many bays with waves crashing into them. Eventually, we saw the touristy sign for Chapman’s Peak. Eh why not, we pulled off. There were some seating built into the peak with people starting to file in. We sat along the railing when suddenly this girl with robin hood green felt shoes hopped over the railing and scaled down the mountain. She disappeared for a while and reappeared. I asked if she is staying down there for sunset and she just waved me down. We followed her down and when we got to her she whispered “Cape Town secret, don’t tell anyone”. She pointed behind her and we saw this inlet in the mountain that looked like a cave. It was the coolest thing I have ever seen. It was a perfect spot for the sunset, away from the crowds, and unobstructed views of the bay. The sun began to set and we popped open the bottle of the wine and enjoyed all the pretty colors. It was one of the prettiest sights I’ve ever seen. A lot of the time I was thinking how awesome would it be to bring all my friends to see this (one in particular : ) ). The sun disappeared as quickly as the wine did and then it was time to go. It was the perfect ending to such a perfect day. I don’t think I’ll ever forget that day. It was a true T.I.A. moment.

Culture Shock Round 2-Cape Town

Obviously it has been a while since I’ve updated my blog. Reasons being that I don’t have as much time as I did in Durban amongst other things. Either way, at least I’m getting to it now rather than never : ) . I just want to start off and say how much I love Cape Town. Upon arrival, I immediately fell in love with the city. It is totally different than Durban. The climate, people, language, and overall vibe of the city is just different. Again, I felt the culture shock slap me across the face. Hailey and I were greeted ecstatically by our program and medical directors, Marion and Avril. They ran up to us and gave us a big hug and welcomed us to Cape Town. Immediately, I felt welcomed and a sigh of relief came to me. We drove to Avril’s house for orientation and were initiated via a song named “Welcome to Cape Town”. How fitting. We were sitting on the outdoor/indoor entertainment area. The sun set and instantly it became freezing. This is very typical of CT, when the sun sets, the temperature begins to plummet. Table Mountain towers over the entire city, wherever you go it just towers over everything. Again I saw the clear divide between success and poverty, more so than in Durban. During Apartheid, families of colour were forcibly relocated to an area called the Cape Flats. It is a massive area containing millions of people in townships and neighborhoods. This is where my homestay is. I live in an area called Athlone, a coloured neighborhood.
I met my family and right off the bat I can tell its completely different. The mom Carol is very nice of course, and the dad George is a riot. The first thing he told me is to make sure the cops don’t bring me home if I’m too drunk. This is also the family that has been with the program for the longest of any other family. Another thing they emphasized was my availability of privacy. I didn’t have too much in Durban since the boys or Sibongile would come in at their leisure. To be honest, I didn’t mind it at all. Actually, I kind of liked it. Either way, it was just very different. But the best part of all, was that the family has a SHOWER!! I was so excited to finally shower instead of taking a bath. After taking baths for 5 weeks straight, a shower was the closest thing to amazing. Dinner is also very different, this family is very independent and you can have dinner at your leisure and it’s never together. Again, no big deal, I am here to live with the family and how they run their lives. I’m not expecting anybody to change the way they live their lives for me. Also in the family, there is three year old Mikayla. She lives with Chantal who is the daughter in-law in a separate part of the house. I see Mikayla all the time and she is cute as can be. She loves to play…a lot. Whenever you ask her how she’s doing, she responds “fabulous”. Diva in the making if you ask me!
That night, Ryan (the previous intern that would leave the next day), Hailey, Lauren, and I went to Camps Bay for dinner. Having no idea what to expect, I was quite curious. My oh my was I in for something completely unexpected. After a 15 minute drive, we pull up to this immaculate, beautiful, palm tree lined, luxurious, amazing waterfront filled with restaurants. You could drop me in Newport Beach and I wouldn’t be able to tell the difference. I couldn’t believe this was Africa! I got out of the car with the strangest look on my face. I was thinking what a transformation this is from where I had just spent 5 weeks in. Also, the raw amount of success and money that’s apparent in this part of town is just astounding. It is common to see a Ferrari roll down the street and nobody attack it. We had dinner at this place called Blues. We were sat down by this lady with a seductive dress and were given luxurious blankets to keep ourselves warm. What the hell, where am I?
Monday morning rolled around before we knew it and it was the first day of work. I ate breakfast and got picked up by our new driver, Uncle. He strictly goes by Uncle and nothing else. Another thing about him, he is EXTREMELY punctual. Since I’ve been here, he’s apologized for being late one time by three minutes. If I remember correctly, three hours late was OK in Africa time. Anyway, we were driven about 5 minutes to Jooste Hospital. This would be the hospital I would stay at for the entire duration of my rotation. Now Jooste has quite the reputation. It is situated in between Manenberg and a couple other gangster towns in the Cape Flats. They have a huge patient population that overwhelmes the hospital all the time. As a result, the hospital has suffered. Jooste has become the Friday night hangout for stabbings and shootings. Also, it’s been deemed the hospital where all hope goes to die. If you have a staggered chance at living, just don’t go to Jooste. Barbed wire and tight security surround the hospital and for a good reason. When word gets out that the person that got assaulted survived, the assailants would ambush the hotel, run to the ward, and finish the victim off.
We were taken to Estelle, the hospital program coordinator at Jooste. Right off the bat, this program seemed very organized. We choose to rotate at the infectious disease clinic for the week. When we arrived there, we were split up and we all had our own doctor. My doctor, C.J., was an amazing doctor. He was young, just completed all of his schooling, and was able to communicate effectively with his patients. I admired all that he did throughout the week. Most of the week consisted of seeing HIV and Tb patients. Overall, it was a somewhat low key week. We would go on rounds on Monday and Thusday with the doctors. I remember one moment in particular however. During rounds on Thursday, we were in the women’s ward attending to some patients. They were examining this very sick woman with meningitis, HIV, and Tb. She has sputum and blood coming out of her mouth and did not have a mask on. I had to stand back from her because it just looked like a whole lot of contagiousness going on. Right next to me looked like a bank vault door. It had a sign on top of it that said “isolation”. I had been by there earlier and the door was shut, abiding by common sense and protocol. This time, with the meningitis and Tb spewing woman to my left, the isolation door was wide open to my riiht. I glanced over at the isolation charts lying on the table, highlighted in pink highlightier was MDR-TB. Awesome, multiple drug resistance Tb air drafting right at my face and I couldn’t really move anywhere. At that moment I realized that I hadn’t seen anybody really throw up. So that made me somewhat happier so I moved closer to the meningitis woman who had just been given a mask. No less than thirty seconds later, she starts vomiting through the mask. I felt so trapped and felt like I was getting hit from all angles with all sorts of dangerous aerosols. I’m hoping I don’t get exposed to Tb (long shot at this point) because if I test positive even as a carrier in the U.S., I have to be put on antibiotics for 9 months to a year. Those medications come with its side effects and eliminate the ability to “party” if you know what I mean. Personally, I think this is insanely overboard for the U.S. (you can’t pass on tb if you’re a carrier), but hey it is the U.S. afterall. From what I’ve observed so far, it is the land of the overly paranoid and wasteful. This is definitely something I’ll take back with me. I hope I can go back and only utilize the resources I truly need and not waste them on uneccessary precautions (i.e. the Tb medication, spending millions of dollars on research for something that happens 0.00001% of the time).

Tuesday, May 4, 2010

Brangelina Day

April 28th, 2010: Today we had went to visit an orphanage about 30 minutes outside of Durban. Today we also experienced “African Time”. We left the house around 7 and got to the bus stop at 7:40 to catch a 7:50 shuttle. We were informed that the bus is on the way and it should be here shortly. The shuttle was just going to take some sisters, Hailey, and I to the orphanage directly. 7:50 came and passed, so did 8:15, so did 8:45, 9:15, and yes even 9:30. Where the hell is this bus? Maybe it was a horse drawn carriage. We kept trying to keep ourselves occupied but a rock hard wooden bench can only be comfortable for so long. The lady behind the counter leaned over and apologized for the delay, “It’s the day after a holiday, it’s always a little hectic”. I didn’t know driving a car could be so hectic but hey whatever. I never got mad or anything, I actually thought it was an entertaining experience. Finally, we got picked up and headed off.
When we got there, we noticed that it was another Islamic compound. Every place we’ve been to in the past few weeks has been of Islamic influence (although some of the implications can be classified as brainwash). We got a tour of the place, fully equipped with prayer rooms and the whole shebang. I wonder if the kids are forced into this religion and what happens if they don’t conform while they are there. We eventually ended up at the ABC, a nice name for Abandoned Babies Cottage. Oh my God I felt like Oprah. A whole swarm of kids came running up the hill with their hands in the air screaming. We put out our hands and got about 90 high-fives from 18 kids. They were playing around on their tractors and tricycles doing their thing. They wanted to get pushed around and be picked up after a while. One boy gravitated towards me immediately. He seemed to be running the orphanage with his rambunctious attitude. Luckily, I liked him a lot too. Every kid cried like 5 times when they got in a fight over a tricycle or tractor. At one point, I had about two and half kids crawling all over me, all of them wanting to touch the ceiling or just be held or take a picture. For those of you who know my passion for kids (FYI, the word passion can be used negatively), you would think I would have lost it. But I really enjoyed running around and playing with the kids. Especially when I would hold them upside by one foot. It was the one really hot day in Durban we’ve had in a while and of course we would spend it outside. I was working up a sweat pushing three tractors at a time and throwing kids in the air. Also, it was a disaster to wear a white shirt to the orphanage. I got pretty filthy with the kids’ dirt, blood, sweat, and tears. They operate in a cascade, once one kid does something, the rest all follow. So if one kid threw dirt in my face, I would get 20 more. Eventually, I was worn out and went back up the hill for a break (this would constitute a tea break). While having our tea, we realized how nice the definition of a break is in SA. I actually felt rejuvenated having tea, cookies, and spending time reflecting what just happened. It was much better than booking it to Starbucks, stressing out in a giant line because you have to be back in time or you’re castrated, getting your caffeine fix to-go, running back before you get a parking ticket, spilling it on yourself, and making it back to your work station so the next person can repeat what you just did (shoutout T! ☺ ).
The rest of the day went fine, when it was time to go we went back to the front office to wait for the shuttle. It would be 2 hours late…again. Therefore, we had tea…again. T.I.A. man.

Malagazi Township Clinic

April 26th, 2010: Case of the Mondays. It was hard to wake up as usual, but I was actually excited once I left the house. Today we were going to Malagazi Clinic in Umlazi, which is a township. This would be the most rural clinic thus far. We pulled into the clinic to see the usual long lines. We were greeted by Clementia, the head sister of the clinic. Overall, it was by far the warmest greeting I have received since being here. All of the staff was so happy to see us and said hello whenever they had the chance. We began by witnessing the family planning clinic, which consisted of a line of women sitting in a chair waiting to get injected with birth control. Like cows getting branded, when it was their turn they got up, dropped their dresses, got injected, pulled their pants up, got their stuff and left…all in front of each other. We injected about 20 women what seemed in like 5 minutes. Next we got to do the regular clinic and sit with a sister. I became extremely excited when she told us Hailey and I had to split up due to the small examination rooms. Finally, I got to be alone with a sister or a doctor for the first time. I went with Clementia and Hailey went with the other sister. The patients started pouring in with a variety of ailments. There were lots of cases with children and adults with sores all over their body. The main cause of this was their diet. Since this was a rural clinic, we got to see the repercussions of malnutrition and poor diet choices. Clementia was a 75 year old sister with a hard hitting attitude to come with it. She obviously has done this for a while, and she sternly lectured everybody about their diet choices and how they’re doing it all wrong. Everything she said was very harsh, but very true. This one baby came in with sores all over his mouth and she told me to listen carefully. She asked the dad (very rare to see a dad there) what the child ate and he responded, “Whatever he wants”. And there is your first problem. A lot of people in this community have no sense of proper balanced diet and give their children whatever they want. They also think that once breastfeeding is completed that milk consumption should be halted. In a community like this, it is close to impossible to compensate all of the vitamins and minerals that are lost with no milk consumption.
We had another patient come in; she was this very beautiful 18 year old girl. She was complaining of a headache amongst a load of other things. We found out she had multiple STI’s and needed an injection. She admitted to not using condoms with her sexual partners and when Clementia asked why not, she didn’t say anything. She just shrugged her shoulders or looked off into space. Clearly, she was impossible to get through. I assumed she would develop HIV in the next year or so.
The most interesting case was this 25 year old man who came in. He didn’t even need to explain himself since he just looked completely emaciated. The sister asked what wrong and he said he has been sick for a couple weeks. She also knew that he had not been eating. He said that he had not eaten in 3 days. I lifted up his shirt and noticed he also looked severely dehydrated. I pinched his abdomen and it felt like I pinched pizza dough. The skin just kind of stayed where I had pinched it, but slowly returned to normal. He tried to remove the rest of his shirt but he had so many aches and pains in his joints that he needed help. He had oral thrush (white coating of the tongue that bleeds when you touch it), which is a good indicator of HIV and a green discharge coming out of his eye. I took his heartbeat with my handy dandy stethoscope and it was beating so fast that I had to recount it a couple times. Sure enough he has tachycardia, or a fast heart beat. We asked him what he has done to help himself out during the few weeks. He replied that he drank a whole bottle of castor oil (not Castrol motor oil…don’t worry). Castor oil is this translucent, extremely viscous, unpleasant smelling oil that was banned in South Africa years ago but has come back due to the introduction of flavors (it still is to be avoided however). It basically acts as an extreme laxative and “cleanses” your body to the point of mass dehydration. The usual dose is a couple tablespoons. Traditional Zulu believe that you need to cleanse the body whenever something is abnormal, so they take a WHOLE bottle of Castor oil only when the sun is down to cleanse themselves. Hence, we see the dehydration. The sister recommended that we stop giving him care and him be referred to the next level of care. The clinic refunded his R40 (~$5.75, the price for all public clinics) since they couldn’t take of him. I asked Clementia how he would get to the hospital and she replied “well he might not, it’s all a matter of how much money he can get to get over there”. It was a pretty sad case to see a 25 year old so sick and only to send him off hoping he has enough money to get to the referred hospital before he dies.
At the end of that case, Goodness (yes that’s her name and she’s 100% awesome) came in and said something in Zulu to Clementia. Clementia turned to me and said that my tea was ready. Umm excuse me? MY tea? What about hers? I told them they didn’t have to that for me and when her tea was. She replied that she only gets tea if it’s not busy, only doctors get tea. Too bad I’m not quite the doctor you think I am… I felt completely undeserving for the tea but they insisted. Hailey and I walked to the back room of the clinic and were pretty touched with what they did. They set up a little table with teapot, teacups, tea, milk, and sugar for us with what little supplies they had. Granted we were having tea on the same table that the birth control medications were administered, I was really humbled by the gesture. To them though, it’s standard to serve the doctors tea. But since doctors rarely make appearances in this clinic, they really tried to make us happy. I busted out my severely bruised banana (my plum had exploded in my bag…sorry Jay) and began to eat it. Out comes Goodness with the biggest smile on her face and apologized for only providing powdered milk. We laughed and said it totally fine only to be greeted with tea cookies. The ones with the raspberry filling…mmm. Again, they really didn’t have to give us cookies.
After tea, we went back into our rooms and continued to see patients. I was sad when the clinic ended. I really enjoyed my day with a fiery 75 year old sister named Clementia. In fact, this became one of my favorite days here. I had the most patient interaction thus far and felt like I contributed to the clinic. I gave Clementia a big hug and told her how much I appreciated everything and headed home.
At home, GoGo continues to blow my mind when I see her hobbling around without her crutch. I don’t think she likes the crutch too much so she manages to get around slowly. A lot of family has been stopping by to check in on her. She continues to smile and also offer me a lot of food… so basically nothing has changed. That night Hailey and I took our brothers out to the arcade to hang out. I bought them some tokens and we all had a good time. On the way back, we had all of them screaming to some rap and even some Poker Face ☺.

Bad Day for the Msomi Family

April 23-25, 2010: After a weekend in Durban, I began what is my last week here. I couldn’t believe I had reached this point in my trip already. I remember landing in windy Durban, completely confused, tired, and expecting anything. Now I feel like I have conquered this city (in my own way. I’m sure I would be conquered in like 5 minutes if I were to step out alone at night). My host family has now become my family and leaving them seems wrong. I have grown very attached to the family. Sibongile is such a respected woman in the community and she doesn’t take shit from anybody. She has raised her boys quite well given she can be quite intimidating. Since she is a school teacher, I asked the boys one day if she’s a cool or a mean teacher. They responded, “let’s just say we’ve lost some friends growing up”. Whatever the case, she has the biggest heart I’ve seen. She will take a bullet for anybody and could possibly kick anybody’s ass. Also, she wrestles with her boys all the time, each time giving them a run for their money. GoGo is the same way, being a GoGo in the household is an interesting position that I haven’t quite figured out. I think it is very revered and are looked at as the ultimate caretaker. GoGo has been through quite a lot in her lifetime. She is the oldest of 6 sisters and has lived in townships the majority of her life. She has gone back to visit frequently for days at a time. GoGo once told me that at one point, there were 20+ people living in her 3 room house in the township. She was the caretaker for that household as well. Like Sibongile, she can probably kick anybody’s ass. She also takes on her own grandkids and wrestles. Probably one of my favorite memories happened this weekend. Boom Boom and GoGo were beating each other up one day when Boom Boom ran into my room and slammed the door behind him, putting all of his weight against the door. GoGo attempted to push on the door to no avail. Boom Boom snickered back at her with his demonic sounding laugh. Before that could end, the door suddenly flies open sending Boom Boom onto the floor. Persistent granny actually charged the door with all of her might and knocked her grandson cold on the floor. At the threshold of my door was a huffing and puffing grandma wearing a yellow sundress. Best part is that her English becomes perfect when she gets angry, “Why are you laughing Boom Boom? It’s not Christmas! I’m going to throw you out that window and show who really raised you!” Essentially, I respect her immensely and do not want to challenge her to any sort of physical brawl. It was the next day that the entire family would be hit with a terribly stressful and sad day.
It was Sunday and the whole family went to church. GoGo goes to a Zulu speaking church while the rest of the family goes to an English speaking church. She walks there and back each Sunday morning and afternoon. It was the afternoon and she still had not returned. We got a voicemail on the house phone and it was GoGo but she sounded distraught and in a panic. There was so much noise in the background that we couldn’t hear anything. Eventually we get a call from Sibongile saying that GoGo was in the hospital. I thought maybe for her hypertension or diabetes but definitely not what I was about to hear. She was hit by a taxi bus while walking back to the house. She was literally the next street over, maybe a 3 minute walk. These asshole taxi buses that I’ve been talking about have added to the statistic. They are so aggressive and do not care for anybody else on the road. All they care about is getting to the location as quick as possible to make more money. They are in the highest incidence of car accidents here in South Africa. The story that went with it wasn’t much better. Apparently GoGo had fallen while she was walking and the taxi proceeded to run her over while she still down on the concrete. The taxi bus ran over her leg and it dragged her for a very short distance. Instead of stopping, the taxi bus kept going. She was put into another taxi and was taken to the hospital where she sustained a pretty nasty set of lacerations on her arm and a broken ankle. She stayed there overnight and was supposed to come back the next evening.
After all of that, you would think that would be enough for one day. But this wasn’t the case. After waiting 10 hours in the hospital, Sibongile came home from the hospital to the house. We helped open the gate and garage so that she could pull into the garage. The driveway is pretty steep and has some gravel patches. On her way up the driveway (driving stick, which she is new at), she slid on some gravel, lost control of the car, and slammed her new car into the side of the house. I don’t know what else we could do at this point… the day was simply not going to be a good one. She hit the house at the right front tire and the surrounding area. I checked out the tires and everything, and the car didn’t look moveable. I know at this point, I would have lost it if it were I. But Sibongile held pretty strong, although I know she holding a lot back. I felt so bad, I wanted to help out somehow but I’m not sure if I really could. To say the least, it was a bad day for the Msomi family.

Friday, April 23, 2010

Johannesburg bound? Or a pretty Durban weekend

April 22nd, 2010: This week has really been flying by. I continue to learn a lot from doing simple research at Dr. Khan’s office. I finished up compiling the information today and hopefully I can produce a memorable senior thesis. The week is so closing to ending and we are getting another car tomorrow. This weekend, we are planning to stick around the Durban area and go to uShaka (waterpark!!! Thankfully Paola isn’t with me or she’ll bring the water park curse), beach, and probably do some more knick knack shopping. Also, we’re hoping to take the SkyRail up to the very top of the Durban World Cup Stadium. But in the spirit of South African spontaneity, perhaps there will be a crazy, poorly thought out, and crazy trip to the mysterious place that is JOHANNESBURG! They say if you can make it in JoBurg, you can make it anywhere in the world. Obviously I won’t be going there to see if I can make it out alive, but to see what this unique, fast paced, and nonstop energy feeling you apparently get while you’re there. There are some cool things to do in the surrounding areas as well. However, this is a long shot since we really haven’t planned anything.

Those in glass houses...

Since this week isn’t the most mind-blowing week, the days have been somewhat uneventful but I have learned a ton. Also, I am getting inside information on why exactly this epidemic is continuing to propagate itself through generations. I saw plenty of cases where the patient does not take his ARV’s for one reason or another and has consequently become worse, developed resistance to the drugs, and then passed that resistant strain onto his usually multiple partners. The scariest information I’ve taken down is that it is common to not disclose your own positive status to your partner who is negative. I feel awful whenever I come across those because the woman truly has no idea what’s coming. Most likely, she’ll get infected and the epidemic continues. A lot of the people who have kept their positive status a secret have had previous partners who have died of an unknown illness (according to them). But really, you could probably guess what it was most likely from. Some of the patients have reported to be taking traditional medicine made by traditional healers, or inyangas. Nobody knows exactly what these medicines are made of but one thing is for sure- it doesn’t help. They suspect they are made from dishwashing detergent, ammonia based compounds, bizarre plant extracts, and some acids. For lunch, we went out walking around looking for something to eat. We were definitely in a very unsafe part of Durban so we needed to find something pretty quick before we look lost. We ended up at this pizza place and had a pretty good meal. When we walked outside the wind was blowing so hard that when we were crossing the street we heard this big smash. All the sudden glass starts falling from the sky and onto the sidewalk, on people, and on top of cars. Luckily, we were just outside of the area where some glass broke so we didn’t get hit. We looked up and a couple windows about 5 or 6 stories up blew out. To paint a grim picture, with all the dust, trash, papers, people running, and glass flying everywhere, it looked like a miniature 9/11. The glass explosions would not stop there. That night, it was actually chilly. And by chilly, I just closed my window and slept all the way under the covers. But we managed to make some hot chocolate. I remembered bringing some hot chocolate mix from home and thought I would never use it. I brought it out for the family to try and we boiled some water (we had no milk =( ). We took some glasses out and started pouring the water into the glasses. Thulani and I were preparing them so I was stirring after he poured the water. As soon as I put the spoon into the water, the glass exploded! I mean a clean cut, side bursting, Mt. St. Helens style explosion all over the floor and myself! Thankfully I’m quick as a damn cheetah and I moved out of the way in time to evade the majority of the explosion.
Later that night Boom Boom and I went over to Hailey’s homestay family for a game called DONKEY. Eager to learn this game, I listened closely only to hear that it’s spoons + horse. First one to spell Donkey loses. When you spell Donkey, you have to do a dare. These dares are already prewritten essentially and they were quite barbaric. Choices included jumping into their pool (this pool’s pump has been broken for months and is full of algae, bugs, green, murky, and probably has a crocodile in it), eat dirt (wtf?), drink half cup of chili juice + chilies, fear factor drink, drink toilet water, streaking, cut off part of your hair, or drink 2 liters of water with one break. I was determined not to lose!! I REFUSED to partake in any of those. Thankfully, I did not lose. Minnie, who is Hailey’s youngest brother lost. We chose the fear factor drink for him. Hailey, her 2 brothers, Boom Boom, and I concocted this drink that I remember consisting of creamed spinach, beet juice, raw egg, salt, soy sauce, peri peri (African hot sauce…its HOT), chili juice, water, cottage cheese, and garnished with a coconut marshmallow. Pretty much it was the grossest thing I’ve seen. It took some strong convincing, including some by Zola, the mom, to get Minnie to even drink a sip. Apparently it was insanely hot. His lips went pretty numb and he began to drool. In the end, he did not satisfy our needs so we dragged him to the pool and threw him in to cool off. It was the first time our families came together, and it turned out to be a great time. Then it hit me, this weekend would be the last weekend in Durban. Next Saturday, I am packing up all my stuff, leaving the family I became very close with, and flying to Cape Town to start all over again. Although very exciting to move onto a new place, to start all over again seems somewhat daunting.

Male..49..vaginal discharge

April 19th. 2010: Back to work :( However, this week would be a tad different. I told our medical director, Dr. Khan, about my thesis on week 1. He offered me to go with him to his office so I could look through all of his files so I can compile some raw data. Hailey decided to join in on the act so we got picked up as usual and were taken to the City Centre of Durban. As we were driving through the City Centre, we noticed a TON of trash everywhere. There had been a strategically planned strike by the municipality of Durban. Right in time for World Cup, the municipality went on strike probably to ask for higher wages. As a result, no trash collectors, no maintenance workers, nobody. Imagine downtown L.A. without a day of trash pickup and how much gets generated everyday. There are no dumpsters so all the trash has been accumulating on the side of the road either in bags or just floating around in loose piles. But of course, T.I.A., and there must be some sort of twist. Most likely in order to speed negotiations, the workers took sledge hammers and smashed and/or turned over all the garbage bins in the area just to add to the mess. There is literally trash in every gutter, every sidewalk, and inside every building. It has been pretty windy here so when it blows all the trash blows up in the air. More than likely you’ll get a KFC box blown into your face.
We arrived at Dr. Khan’s office that is in a private hospital. This is an opportunity that no other intern has yet to see. All previous plans are with public institutions. I wasn’t expecting to see anything special this week but at least I get to compare. The building smelled like smoke but there were no long lines, not under staffed, no feeling of helplessness. We got into the office where we get put to work going through the files. We sit in a tiny table right behind the receptionist, Abigail. Patients would come in occasionally but never anything like the overload we’ve seen at the hospitals and clinics. Dr. Khan checks on us frequently which is nice and answers all of our questions. He proceeded to ask us if we wanted to witness a surgical procedure. Thinking it was an abscess; I was ready to take it on. Noooope, it was something new again. It was an adult circumcision. I was happy we were in a private hospital for this because I wouldn’t be surprised if the pubic sector bludgeoned the foreskin off with a butter knife from the upstairs café. The patient was taken back into a room and was prepped for this procedure. As a guy, it was alarming to see what was going to happen. Hailey seemed fascinated. Dr. Khan outlined the procedure to the patient and to us. He gave the patient a couple shots in some unfamiliar places (yes it looked like it hurt) and apparently he was numb. The procedure was quite simple… simply pull and slice 3 different times and stitch back up. He asked if I wanted to help suture up. The last part of the body I thought I would do my first alive suture would be a freshly circumcised penis but hey I’ll take anything. Unfortunately, I wasn’t technically “properly scrubbed in” so maybe next time. After that, Dr. Khan gave me a sex talk that I wasn't sure I was ready for...or anticipating. Obviously, 98% of the information was uninformative for me.
Going through the files was quite cumbersome at first. It was hard to locate the information I actually wanted and how to actually sort it out so it became easier to read. I took down CD4 counts, viral loads, age, coinfections, if they disclosed to their partner about their status, and their partner’s status. Some of the files had some major booboos. For example, I found a man with vaginal discharge. That one left my head scratching. Also, there are missing pages and some mix-ups in patient names.

South African gem

We awoke on Sunday to have some breakfast on the terrace and got ready for our massages. I noticed my upper thighs were pretty sore and was confused as to why. Then I realized I am so out of shape. What made my thighs sore was simply the ocean. The strong currents I walked against were enough for a good work out.
My massage was magical to say the least. I managed to talk to the lady the entire time. Her name was Joy and she was an amazing lady. We talked about pretty much everything and I still managed to enjoy the massage. I was greeted with a fresh juice cocktail (score! My favorite!). Hailey got pampered for 3 more hours after I was done with my 90 minute massage so she thoroughly enjoyed herself to say the least. Since she stayed so long for all her treatments they gave us another room to hang out and shower after. Finally, we packed our stuff and said goodbye to the great staff and headed out. We stopped by Margate beach and had some food. There were vendors selling more African crafts along the beachfront. Like an addiction, we had to barter for some more. We decided to eat at muffin haven AKA Mugg and Bean. This would be muffin to-go attempt #2. When the waiter asked what we wanted, he was blown away by our accents. He asked where we were from and we said from California and Washington and he about had an anxiety attack. He went into complete hysterics like we were a piece of royalty and fled our table…forgetting our order and our menus. To this date, I say this was the best reaction thus far. The entire weekend was great beginning to end… none of the previous interns that we know of came here. It was nice to go off the beaten path and explore something new only to find a true South African gem.

Me vs African sun-Weekend edition

This weekend Hailey and I decided to head to Margate. Margate is a quaint beach town in the South Coast. We rented our trusty automatic, the Nissan Tilda. We made reservations at the Ingwe Manor Guesthouse that looked pretty nice and had a spa that we were considering checking out. The drive was pretty scenic and picturesque. It was right along the water most of the time with women selling fresh fruit along the highway. We got there in an hour and pulled into this place that was surrounded by an electric fence. Thankfully, we’ve come to appreciate the electric fence for what it’s worth. Although an eyesore, it was reassuring knowing that no mob was going to hop the fence and take over this European infested place. We were met by Tanya who showed us to our room and we were amazed! It was this incredible room with a sea view to match it. Elated, we changed into our bathing suits and headed straight to the beach. After stopping at Mr. Fish for some fish and chips, we found ourselves at a beach. What was interesting was that it was half beach and half jungle. On one side, you had the Indian Ocean with fine white sand. The other side was filled with limestone cliffs, an estuary, and lush vegetation. We stopped by this little store to check what was inside. We found this tanning oil (which we don’t have) that was simply labeled “Coconut Island Dark Tanning Oil” and that’s it. With the exception of a pretty palm tree printed on it, there were no safety seals, no ingredients, no location where it was made, no smell, no SPF, and it was bright red. Feeling adventurous, we bought it. Perhaps we bought a bottle of cancer, but T.I.A.. We threw off our clothes and immediately started lathering up and were apprehensive to put this stuff on. Eventually we said screw it and put it on. When we tried to wash our hands in the water, it looked like an oil spill had occurred. This stuff was 100% waterproof and was now probably clogging every pore in our bodies. Since it was too late now, we just relaxed and soaked up some much needed sun. The crowd was generally European, with 85% seeming to be German. We saw a couple negatives (nifty term for white people who have probably lived under constant sunlight for 45+ days. Now, they are dark as hell with a leathery texture and have bright white teeth, and bright blonde/grey hair, kind of like a photo negative.) After being broiled under the sun, we tried the ocean. I have never felt such a stronger side current in my life. After being swept out at Zuma a couple times I thought I could handle this. At first impression, I was doing fine. Hailey was getting tossed around like a rag doll but I got some sort of enjoyment out of it. The entire day at the beach was so relaxing and Hailey and I were able to reflect on our experience thus far. We are on week 4 of being in South Africa, and we have definitely seen our fair share of highs and lows. Additionally, we have already realized some of the things we take for granted back home.
The sun was starting to disappear over this cliff around 4 so we decided to pack up and leave. As we were driving back to our room, we parked and decided to get some ice cream. This jolly Italian man flagged us over to his shop and started elaborating on how great his ice cream was. We became slightly apprehensive and were eyeballing the Milky Lane across the street (Baskin Robbins of SA). However, we felt somewhat bad so we bough some ice cream. Let me say it was the best decision of my life. This ice cream was amaaaazing. It was truly homemade gelato with some great flavors. I got this almond ice cream with chocolate chunks + crème caramel with a homemade cone dunked on top. I inhaled it leaving ice cream all over my face as usual. We came back to the guesthouse and saw a 90 minute massage for a pretty good deal. We made an appointment for the following morning after breakfast. Hailey went on a slight spa binge and booked an additional manicure, pedicure, and hair treatment.
For dinner we went to this Italian restaurant and ordered a pizza and a sandwich. The waitress asked if we wanted any wine and I jumped on it. She offered some free samples of the wines, all South African. We ordered a sample of a white wine, a rose, and sangria. Their sample consisted of a regular wine glass filled almost ¾ to the top! “Stuck” with 3 glasses of wine, we enjoyed them tastefully. Lightning began to appear in the sky but with no thunder. We didn’t think much of it until it started drizzling 30 minutes later. Without any notice, it turned into this torrential downpour. We rushed underneath the overhang and switched tables. The rain was coming down so hard and the lightning was so bright that it made it quite the entertaining nightshow. Then, the power went out in the restaurant and we were left in the dark. Luckily, our food had just finished cooking so we didn’t have to wait any longer (and trust me, when you go out to eat in SA, you’re going to be out for a loooong time). It seems like they’re just slaughtering the cow when your order a burger. It wouldn’t surprise me, but I’ve just learned to wait patiently.
After a spending a marathon of time in the sun, I knocked out pretty early. Jayson woke me up with multiple phone calls midway through my sleep. Since I’m such a great person, I trecked over to the lobby and skyped with him for a little bit.

Saturday, April 17, 2010


April 15th, 2010: Day 4 of surgery at King Edwards. After a chaotic day yesterday, Hailey and I went in with high hopes for a successful day. We headed up to the surgery ward and ran into some interns we had met from yesterday. They were just ending rounds and were about to split up. We stayed in the female section of the ward for the first half of the day. The intern needed to remove some sutures from the eyelid of this lady who just had surgery there. He asked for our help because she previously aggressive when they were trying to examine her. The nurses said, “I don’t want her to hit me again!” I looked over at the bed to see this old woman curled up in the fetal position. She looked like she could go Exorcist on me at any moment. Luckily, she wasn’t too bad. She was an old woman in pretty bad shape however. She couldn’t speak and had scars all over her body. I think she was mentally disabled as well. Curious, I opened the chart and started looking at her information. What I read was pretty horrifying. The first line I read was “Bushknife assault”. This woman had scars all over her head, body, legs, and face. The assailant had attacked her with a bushknife so savagely that it fractured her skull multiple times and caused her to have motor impairments on her left side. Her vision was deteriorating and she was just somewhat mindless. I continued to read in the chart and came across the following line “Son attacked patient with bushknife”. Her son apparently acted out of complete rage and slashed her all over her body to the point where she was incapacitated even further. It was pretty sad stuff to see, but these kinds of attacks are somewhat common in this area.
After caring for her, we checked on in the woman with cellulitis. She has been improving since the previous day. It was kind of cool to finally track a patient for more than one day and see some progress. As I rounded the corner to check on the next patient, I saw a familiar face that I thought I would not see again (nor would I want to). She turned over and saw us and gave us a friendly wave and said hi. It was the hemorrhoid woman from the gynie clinic. She had been transferred to this unit for some reason and here she is again…. hemorrhoids popped out for the fourth time. The doctor told us that he was going to try and push them back in again. This would require her being knocked out again and going through all that pain. Even better, we were the only people in that ward who had witnessed the surgery yesterday so we had to stay and tell them if the hemorrhoids had gotten any better. The patient had such a good attitude going into this whole thing, she was joking to save the anesthetic for after the procedure was done. So the procedure happened again, but this time I stayed pretty alert! I did not get queasy at all and was actually able to assess if they had gotten any better. I stayed with her until she woke up and felt just dandy. I wandered around the ward after that trying to find something to do or see. I was feeling pretty good and somewhat involved at this point. I saw the curtain pulled around this bed and decided to take a look. The nurse was taking off the dressings off a wound that spanned this woman’s back. I saw her carefully pull back the dressings to see these huge what looked like burn marks. I asked what happened and she got into a nasty car accident with one of those taxi buses (very common) and she got ejected onto the road and what was on her back was road burn. Ouch! The nurse then put some ointment on her back with a popsicle stick and it did not look like it felt good at all.
The next patient was downstairs in the high care unit. I was guessing that it would be some sort of anal problem. Well… wouldn’t you know, I was right on the money. We approached this lady who was definitely afraid of doctors. She had this terrified face on her and was apprehensive to let anybody touch her. I grabbed her chart and took a look. Eight days prior she had her sigmoid and rectum entirely removed because she had cancer in that area. She hasn’t been able to move this entire time and consequently developed bedsores. Further, I think she was pretty embarrassed, I could see it on her face.
Coming away from that patient, a doctor pulled us aside and just started talking to us and asking why we were here and how South Africa is going. He was very interested and engaged in the conversation. He gave us some an awesome opportunity at that point. He gave us a patient for ourselves. He emphasized the value of examining a patient and trying to see what’s wrong without the patient telling us how he/she is feeling. He gave us this man with a head wound and told us to examine him and see what special signs he is displaying. The doctor left the room and left us with this man who could barely speak. He had a pretty sweet laceration across his forehead and was pretty disoriented. I asked him to wiggle his toes, follow my hand, and see if he could feel my fingers on his foot. I noticed he had a left side motor skill deficiency among other things. The doctor came back and we reported our findings and we were right on with the majority of our findings! He was pretty impressed with us and continued to explain his condition. The patient had been hit over the head with a spade (South African for shovel) by his amigo. They were both drunk and now this guy has a pretty severe sub-arachnid brain contusion. Apparently his friend who hit him over the head brought him in…arm in arm laughing about the situation not knowing how severe it really was.
I know the previous couple of days have been somewhat brutal and frustrating for me. Whatever the case, I am enjoying my time here and soaking up the experience. Within the past few days especially (Friday went very well too, just to foreshadow), I really have enjoyed my experience on the jobsite and I’ll continue to have my positive can-do attitude there and then try to untangle my true feelings on here. I know it’s coming off as if I’m complaining most of the time, but let me just put this out there. When I write these blogs, they are uncensored, unedited, and sometimes not pretty. I write down how I’m feeling as raw as I can so the people back home can get a sense of what it is like over here. I am well aware that having the opportunity to experience something like this is rare. Directly, this experience is not pretty, it’s not glorious, and it’s not easy. I am not here to check little childrens' heartbeats, put band-aids on minor cuts and scrapes, or dangle little toys to help keep kids from crying. There is no time, no resources, and no advantages to doing such things here. The theme of healthcare in South Africa as one doctor put it kind of goes like this, “One thing the South African healthcare system teaches you is apathy. You appreciate and learn it because if we didn’t have that ability, there would be no doctors in South Africa.” Indirectly, when I arrive back home, I will be able to realize what exactly I have back home and how much of a valuable experience I just had. I love this continent and this country; this is one of the reasons I have returned. Obviously I am not on a 20 day safari, I am not getting serenaded by Zulu dancers with a gin and tonic in hand, and I’m not getting a detailed guided tour of everything beautiful. I returned to see the other side of Africa and work within its constraints. With that, that edited version with smiley face stickers can't be found here.