Just arrived in Capetown after a 29hr (from start to finish) journey from San Diego. Thinking hard about figuring out how to get "Gold Mileage status" so that I can sit with the bigwigs in business class and stretch my skinny legs next time. Needless to say, I'm a little tired.. Excited about the adventure that is about to begin. Love the group I am travelling with. Stay tuned...
I'll try and upload the first video of us in DC waiting for our flight to Dakar (Bill, Larissa and Marty with their deep thoughts).
http://www.youtube.com/watch?v=ziF-rhAA-m0
2/5/2011:
Just had another day of amazing speakers (hate to over use the word, but they were truly “inspirational”!) The highlight was hearing former Ministry of the Treasury speak to the Rotary Club about South Africa and its future. It was simply amazing to hear him crystalize so succinctly the problems facing South Africa and also discuss the potential future role South Africa (and Africa) could have on the global economy, with the overall message that South Africans need only rise to the challenge in order to succeed. It is impressive to see that there are still great visionaries and leaders that exist in our time, it’s just a shame that sometimes the policy makers or people in power do not heed their advice! This was truly a treat to be part of the Rotary International Convention; good to be around people who not only talk the talk but also walk the walk.
The afternoon was spent at Robben Island (the island off the coast of Cape Town) where Nelson Mandela and many other anti-apartheid leaders were held as political prisoners. The tour was led by former political prisoners who added an eerie sense of the cruelty of apartheid and it’s systematic de-humanization of black Africans. Horrifying to think that mankind could do such a thing. I was left wondering about the triumph of the human spirit and being amazed at how many political prisoners went to jail for what they believed in, and stood true to their beliefs despite, torture, threat of life and physical harm, and being ripped away from their families. Made me question whether if placed in a similar situation whether I would be able to be strong enough to stand up for the right thing despite all the sacrifices it would take. Made me appreciate all the people who despite all threats of harm and hardships, still had the strong will and moral fiber to stand for what was right. And because of their strength, that today black and Indian people can walk free without the subjugation of apartheid. (I guess the same story of the triumph of the human spirit rings can be said of the civil rights movement in the US or the holocaust in Germany. I’m still in left blown away thinking about both the depths of cruelty that mankind can sink too, but also the peaks of strength and forgiveness that it can also rise too.
The somber afternoon was followed by a Rotary International Cocktail party at a Cricket club. Brings back memories of my British days of being a school boy playing cricket.
2/6/2011:
This is our last day in Cape Town before leaving for Pietermaritzburg. Weather not cooperating for a cable car trip to the top of Table Mountain so the group decided to take a trip to the Cape of Good Hope (The Southern most tip of the continent of Africa). Beautiful ride down the coast where we got to see the scenic coast line. The sun peaked out as we approached the Cape of Good Hope. Got to see where the cold Atlantic ocean meets the warm Indian ocean. The earth has so many natural wonders to offer, the pictures don’t do it justice.
Arrived in Durban 1hr late, bags did not make it on our flight for some reason so had to wait in the airport for the next flight to bring them in. While getting our cellphones, the Vodacom salesmen started to break out in hives and lip swelling. Had to kick into Peds Emergency Doc mode and rush over to the pharmacy to get him some diphenhydramine. Luckily, we were able to get our cell phones before he keeled over! He gave me my SIM card for free, a small token of appreciation to pay for saving him from anaphylaxis I guess. Rain was pouring, sticky humidity, a distinct change from Cape Town. Got a rental car which I drove on the left side (with Marty riding wing man) to Pietermaritzburg in one piece
Arrived in Pietermaritzburg at 10pm tired but eager to get some rest so as to be refreshed to start work on the project in the AM.
Arrived in Pietermaritzburg at 10pm tired but eager to get some rest so as to be refreshed to start work on the project in the AM.
Met my host family, Moussa and Lorraine, who are the absolute kindest, warmest and most accommodating people in the world. Despite the late hour, a warm meal and a cold Castle beer was ready for me to eat and drink. We spent a couple of hours getting acquainted and realizing that we had much more in common than anticipated. A perfect introduction to my Pietermaritzburg stay. Slept like a baby in anticipation for the busy day that lay ahead!
2/7/2011:
A full day planned which started with a brief overview/orientation that started with Henne telling us about what to expect. Loved his analogy of us being more like an elephant (big ears, small mouth) versus a toad (small ears, big mouth) in terms of our initial approach the hospitals here in Pietermaritzburg. We then spent the afternoon with Neil M., the regional pediatric chief, super smart, super driven and realistic about expectations. He gave a fantastic overview about South Africa, the population, the demographics, the major illnesses affecting its pediatric patients. He also went on to discuss the structure of health care in SA, the different tiers of clinics/regional hospitals, the lack of resources, lack of sufficiently trained staff and nurses etc. The opportunities for intervention are many but he specifically wanted us to spend the next few days observing the wards, NICU, PICU, talking to doctors, nurses and families to get a better understanding on how the system works before deciding where we can plan to intervene. This makes perfect sense, especially since none of us truly have any idea on how things work on this side of the world. The day/afternoon was concluded with us touring Grey’s Hospital. It was good to play the Elephant and will gladly continue to do so as I absorb how things run so differently on this part of the world and try to figure out how and where we can make the most difference.
The day concluded with a lovely home cooked curried lamb meal with my host family and after dinner visit to friends of my host family who happened to be Ophthalmologists at Edendale hospital. A very furtive discussion ensued about where they thought our time and resources would be best used. And thus the adventure begins!
2/8/2011:
Today and most of the ensuing days are going to involve us observing the various areas of the hospitals, regional facilities, primary health care community clinics in the hopes of better understanding the state of healthcare in this region. Today was spent at Edendale Hospital (the former “black” hospital during the apartheid era). Needless to say it was in a significantly worse state of disrepair as compared to Grey’s Hospital that we saw yesterday. But despite the lack of funding and equipment, they still had the basic supplies (oxygen flow outlets, monitors, limited IV pumps, outdated ventilators). Perhaps the two most striking things were 1) the lack of adequate space to see and manage the large volume of patients that are presenting to the hospital, and 2) the serious lack of coordination and/or communication between the physicians and the nurses as well as the surprising lack of interest/urgency exhibited by the nurses when it comes to patient care. Clearly, these are not things that we can fix easily during our 4 week stay here in Pietermaritzburg, but it sure would be nice to try. More pertinent to my background, I had the chance to meet Dr. Anu who works in the equivalent of what would be an ED here at Edendale hospital. The waiting room was packed, the housestaff were working hard (while smiling through it all). Only 6 rooms to work with, and 2 “resusc” beds. Quite impressive indeed. Looking forward to spending more of my time down there trying to figure out where my knowledge and expertise might be most useful. Ended the day spending the afternoon, facilitating and supervising play for the kids that were healthy enough to play outside. Quite enjoyable indeed (although it was steaming hot, playing in the afternoon sun)! It’s difficult being the elephant (big ears and small mouth), but at this point, I can clearly see it’s value. Through questioning and observing, I am slowly beginning to see the context of how things work here in South Africa and while I am sooooooooo eager to jump in and do something or anything to help, it would be more prudent if I instead be more educated about where my skills and efforts would be best used.
As always, the day was topped off by a wonderful home cooked meal, with the lovely company of my host family Moussa and Lorraine. These are two of the most woderful and interesting people I have ever met.
2/9/2011:
Today was yet another eye opening experience. Instead of a day at the hospital observing, we actually went out into the “field” with an organization named Thandanani Children’s Foundation (an NGO that helps support through training, education and providing resources) orphaned HIV/AIDS children by going into their homes to help provide the orphans and their families with the necessary skills to cope with the hardships. If anyone reading this is looking for a worthy organization to donate or contribute to this is clearly one that has a clear need, and a clear action plan to go with it. Check it out at www.thandanani.org.za The director Duncan Andrew is yet another enthusiastic visionary that has done wonders in creating a program that is self-sustaining but is so multi-factorial in its attempts to tackle the problems that face HIV/AIDS orphans in this region, that it should be a model for other HIV/AIDS stricken communities world wide. Visiting the organization not only helped us learn about the great NGO but also allowed us to go into the Edendale valley where to see the homes and lifestyle these orphans are faced with and see some of the success stories this program has managed to produce. The scope of HIV/AIDS devastating impact on the South African community is too numerous to count, there are few NGOs that attempt to attack the problem on so many levels but the Thandanani Children’s Foundation appears to have successfully done so. We ended our tour visiting some a hillside cemetery that the community of Edendale Valley use to lay their loved ones to rest. Kind of an eerie place to be because of on the the one slope you have rolling hills of graves with crosses extending in all directions but on the other slope of the valley you see flowing green pastures of grass and fertile land. The land that was once fertile and arable, has now become a resting place for the victims of HIV/AIDS! These increasing number of graves have slowly started to take over the beautiful fertile grounds of the valley adding yet another dimension to the devastation that HIV/AIDS has imposed on this community. See picture below: Again just another image that drives home the effect of HIV/AIDS on this poor community.The evening events were somewhat lighter than what we saw earlier in the day. A nice cocktail reception in our honor was put on by the trustees of Grey’s Hospital. Had the chance to have some very fruitful conversation with Dr. Sue H. and Dr. Anu who are pediatricians that have had a particular interest in advancing the concepts of emergency medicine and critical care management here in Kwazulu natal. Both are also super smart and super enthusiastic about learning more about how to better the delivery of acute care to the children of the region. Tomorrow I will be spending the day with Anu and am eagerly awaiting to hear more about the system currently in place here and also discuss how the system in the US differs from what is currently available here. Hopefully this discussion and discourse could be the start of trying to design a specific project that involves my skills and interests to fill their holes and needs. Still trying hard to be that proverbial elephant with big ears and small mouth!
2/11/2011:
Yesterday and today, I pretty much spent observing in the POPD (Pediatric Outpatient Department), kind of a combination clinic and their equivalent of an ED. Primarily spent the day talking with Anu, a young British doctor, trained in Liverpool, who worked at Medecins Sans Frontieres (Doctor’s without borders), but has now taken on an attending position as the only supervising doctor in the POPD. Kind of reminds of what or who I would have been if I had not chosen to take a position at Rady Children’s after fellowship. He’s a super energetic guy, enthusiastic about changing the world, trained in Western medicine but super astute about how to practice medicine in resource poor setting. They talk about the big 5 when you’re on safari, but talk about the big 3 when you practice medicine in Africa (HIV, TB and Malnutrition). You can’t even fathom the number of patients in their waiting room, it’s even more amazing when you think the miles they have travelled and the hours they have waited to be seen! Simply astounding. Residents and trainees see patients non stop all hours of the day at the POPD. On this Fri there were 2 patients ~toddler age that were essentially dead on arrival, which is about how many I see in a year back in San Diego A stunning statistic: an estimated 40% of children die before arriving at a hospital and a significant majority of those remaining 60%who do make it to the hospital die within the first 24hrs. Which makes what I do as an Emergency Medicine physician all the more important. The amount of HIV seen and all it’s complications is simply mind blowing. Anti-retrovirals when instituted early and consistently has drastically improved the morbidity and mortality. So much work to be done here!!!
After a long day, I finally got to meet with some of the critical care and emergency medicine minded pediatric docs here in Pietermartizberg. Talked about the differences in resources, differences in nursing skill and interest level. Also got to talk about the ‘big picture’. While coming here and seeing 10 or so patient’s in the clinic might be helpful, the ability to implement a simple but effective triage system, or the ability to educate nurses and trainees about recognizing and managing critically ill patients, and the ability to set up ‘systems’ that would prevent bad outcomes is so much more long lasting and so much more of an impact. And that is what the docs of Pietermaritzberg hope to get from me!
2/12/2011 – 2/13/2011:
My first weekend here in Pietermaritzburg was a culturally rich and fun filled weekend with my host family. I was graciously taken to visit the children and grandson of my host. While my host is not a strictly devout muslim, his daughter and grandson are on the other end of the spectrum. Had the chance to watch his grandson practice archery (a sport I haven’t done since adolescence). The this Sat morning lesson was at the Muslim school that the grandson attended which was also quite interesting.
On Sunday, my host family was kind enough to take me and Larissa on a leisurely drive into and around the Drakensberg mountains. The scenery on the drive up and into the mountain were simply breath taking. The finale was when we approached “The Golden Gateway”, a spectacular pastel colored rock cliff formation that was in the heart of the Drakensberg mountain range. Another one of god’s hidden treasures on this planet. The pictures don’t do it justice.
I think you meet people for a reason, and I feel so fortunate having met my host family, with them having welcomed me into their home, feeding me and taking their precious time to show me their beautiful country.
