Sala Kahle

Let me take you back to an easier time...

2011-08-11T12:51:00.000-07:00

December 2010.

I had recently finished my job with Baylor and was off on a wonderful 3 week adventure in India with Tini and Nick. We had an amazing journey and filled the days with a lot of adventure. If eating allowed us to, that is. I think that is where I will start since it was such a focal part of our journey.

This is not going to be a surprise to anyone, but food in India is ridiculously good. The best part is that you can eat so much because it is also so cheap. We were mainly in northern India so that is what we ate the most although we also sampled some South Indian food as well. Favorites were aloo parathas, dal, tandori, korma, biryani, paneer, naan, roti, raita, masala, etc, etc, etc. Nick, Tini and I coined our dining experiences "eating tours". It was very difficult to settle on just one place to eat so we often "sampled" a couple dishes from two or three different restaurants for each meal. How did we choose these restaurants? It definitely was not on any sort of health inspection scoring, but rather the number of locals that were eating there. Believe it or not, I think this might actually have been safer because all the food was prepared fresh in front of us. Maybe that is , but I can tell you I made it three weeks in India without getting diarrhea. Here are a sample of our favorite places.

First meal at a popular chain restaurant called Haldirams. This was probably the cleanest place we ate. Also one of the few south indian meals we ate. Here I am enjoying a Dosa.

Late night dinner with Tini's cousin in Delhi. This was not only young college kids out late, but families as well. If women and children were eating at a restaurant it often made us feel a little bit better.

Our favorite place in Agra. No women and children, but plenty of men. We had to sit up stairs in the loft.

Eating on the roof in Jaipur. One of only a couple lonely planet suggestions we followed.

New year's dinner of thali in Jodhpur with Tini in her beautiful sari.

We were also treated to multiple home made meals in Delhi and Jodhpur prepared by Tini's aunts.

We had lots of good eating spots in Jaiselmer. Our first night, we splurged for the only bottle of wine we had the entire trip. Wine is really expensive and not great. Besides the pollution this might have been the only downside I saw to India especially coming from South Africa where we can get such good, cheap wine!

Jaiselmer was one of my favorite spots. It was a nice change to the hussle and bussle of Jaipur and Jodhpur. It was also beautiful situated around a fort sitting on a sandstone ridge. There were many restaurants situated overlooking the fort to stop eat, drink, watches kites fly and enjoy the sunset on the golden sandstone.

One of our favorite dinners was in Jaiselmer and we just happened upon it. We were checking out a lonely planet recommendation when we spotted a tent like structure just across the way. We followed our noses to a great treat.

Another favorite was this gentleman who we were lucky enough to happen upon working out of a small room with a window to order from. We were not able to read anything on the menu, but just had a good vibe. Luckily we had Tini who could converse with him in Hindi and ask him for his specialty. He made us an amazing tandori chicken as well as a chinese chicken dish. It was one of the rare meaty meals we had. Tini found out that he used to be the top chef at a popular hotel in Udaipur, but then decided to start his own business. There was only one table as most of his business is take away. This is where Nick made the fateful mistake of drinking the water and spent the next day in bed.

Finally, Calcutta. What can be said about Calcutta? So much delicious, cheap street food. Tini's parents had stopped trying to shelter us from food at this point and Tini's dad bought us this dish filled with a liquid broth. This was the only time I feared the consequences of my food choices especially since we would be getting on a plane in a couple days, but I survived. My favorite, though, the rolls: Chicken, egg, chicken and egg all too delicious to describe.

Oh, my mouth is watering just remembering all the wonderful food!

A Swazi Traditional Treatment

2011-08-10T11:26:00.000-07:00

I am not even going to mention the last eight months. I have no excuses. I am hoping to restart from now. If I find myself super motivated and with a lot of free time, I will try to post about the highlights of the last eight months.

Today I was in one of the clinics my ICAP team supports in the Lubombo region. It is a relatively new clinic for us, but they are doing really well. They are testing pregnant women, retesting every two months if HIV negative, sending CD4 if HIV positive, enrolling patient's into the preART program and referring to a close clinic if the client needs initiation on medication.

PreART has been a new initiative and focus by the Ministry of Health. Before the last year, HIV positive clients were only enrolled into care and followed if their immune system was weak and they qualified to start the antiretroviral treatment (ART). The ministry then recognized the importance of early identification and early initiation on medications to prevent people from ever becoming sick. In an attempt to standardize this a preART program has been introduced. When a client first tests positive, the client is enrolled into preART. Baseline CD4 is sent. If the CD4 is low or the patient is sick, they are referred to start medication. If the CD4 is still greater than 350 or the person is well, the client is put into the appointment register to come back for cotrimoxazole prophylaxis (to prevent certain pneumonias and diarrheas) and repeat CD4. With the registration of these clients and the clients booked for actual appointments, it is then possible to follow up the patients if they miss appointments. The end goal being healthier clients initiating ART.

I got side-tracked. The point of this post actually has nothing to do with HIV. While sitting mentoring one of the nurses and an expert client (a lay staff member who is HIV positive), the nurse told me the expert client was sick. By my definition this is not exactly accurate because her problem was a "wart", which to me does not qualify as being sick, but I digress. She said the wart was growing and causing her pain when sitting because it was on the back of the leg. I suggested a medicine that I know is available in the clinics, but of course they had tried it. I then commenced trying to describe duct tape and the belief that if kept covered for weeks it might help the wart. I explained though that I was not sure if this was actually worked or not. They then told me about the traditional Swazi treatment for a wart.

Step One: When it is lightening, get a grass broom and open the door.

Step Two: When the lightning flashes, sweep the wart with the broom.

The nurse did not believe that this actually makes it go away, but the expert client did. Her problem: the wart is on the back of her upper leg so it is very difficult to sweep with a broom. And no, you cannot have someone else sweep. You must do the sweeping yourself. Seems like a good addition to covering the wart with duct tape to me!

In the end, I actually do not think this was a wart, but a skin tag so I referred her to the hospital to have it removed. I sure enjoyed the conversation though!

A few links about the protest

2011-04-12T12:14:00.000-07:00

International news of course...curious to see what will be in the Swazi times.

http://www.nytimes.com/2011/04/13/world/africa/13swaziland.html?_r=1

http://www.thedailymaverick.co.za/article/2011-04-12-swaziland-april-12-uprising-reports-from-the-ground

http://www.bbc.co.uk/news/world-africa-13046740

Free speech, tear gas and rubber bullets collide in Manzini

2011-04-12T12:07:00.001-07:00

I need to start carrying my camera again

2011-04-12T07:29:00.000-07:00

Actually first I need to find my camera again. It seems to be one of the casualties of the move.

Regardless, I wish I had it today when I walked out of a clinic room after seeing patients to find a chicken in the hall eating crumbs off the ground. The chicken proceeded to wonder around enjoying the many treasures it found until it was full and wondered out of the clinic. Noone, including clinic staff and patients, seemed to give it a second glance or thought. I guess it is a true "community" clinic.

Trouble in the Big City

2011-04-11T11:03:00.000-07:00

This morning driving from Mbabane to Siteki, I went through 5 police road blocks. The police and army have been out in full force since last Friday. They have effectively covered every entrance into the country and every road into and out of Mbabane and Manzini. Why? This is in response to what has termed the "April 12 uprising". April 12, 1973 was the day that political parties were banned in the country giving the monarch absolute power. Three labour unions, Swaziland Federation of Trade Unions, Swaziland Federation of Labour and the Swaziland National Association of Teachers, have planned three day protests/strike starting tomorrow, April 12. There is also talk that COSATU (Congress of South African Trade Unions) and the ANC youth league will be somehow involved. The main march will take place in Manzini and is techincally illegal. It is unclear how large this "protest" is going to be and what the response of security forces will be. It is being taken seriously, though, as evidenced by the road blocks and the random soldiers walking the streets this weekend. I guess after the recent fates of other autocratic rulers in the Africa, that is not an unreasonable response from the government. Based on my two and a half years in Swaziland, I have a hard time believing that there would be enough momentum and support of these protests to really have any effect, much to the dismay of many ex-pats. Others disagree. I guess we will see over the next few days. One thing I am sure of is it will still be quiet in Siteki!

Where were you last year?

2011-03-18T10:51:00.000-07:00

I was in Benghazi, Libya from March 13-19.

Then in Cairo, Egypt on March 20.

A lot has happened in a year.

Nurses Shut Down All Hospitals

2011-03-15T11:33:00.000-07:00

This was a headline from the Swazi Times last Wednesday (article attached at the bottom). The nurses were striking because they had not received their overtime pay since the beginning of the year. Despite a judgement from the High Court stating that the nurses should return to work, the strike continued through Friday. In a country where the health care system is driven by nurses this sort of action has a huge impact. The community clinics are run strictly by nurses. This includes well child care, immunizations, prenatal care, sick visits and in some clinics ARV refills and initiations. The hospitals, while they do have doctors, were still severely crippled by the strike. While in the ART clinic last Friday at Mbabane Government Hospital, an admitted patient came down from the inpatient ward to the outpatient clinic to receive help because there was no one to help on the ward. Patients were backed up in the outpatient departments waiting to be seen by the few military/correctional nurses, who had been called in for emergency care.

Luckily the nurses were back at work on Monday. Unfortunately, this sort of action might be a recurring event. The government of Swaziland is facing a serious economic crisis. There are rumors of changes including possible salaries cuts for civil servants from the top to the bottom. It will be interesting to watch over the next few months the steps taken to combat this crisis and the local reaction to it.

NURSES SHUT DOWN ALL HOSPITALS

10 March, 2011 10:00:00By Faith Vilakati

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The Mbabane Government Hospital

THE nation is warned to take sick relatives to government hospitals and clinics at its own risk because nurses have engaged in a total shutdown strike starting from today.

This applies to all public health institutions in the country.The nurses will not be attending to any patients until further notice. By afternoon yesterday the walls of the Mbabane Government Hospital were ‘decorated’ with notices informing the nurses to down syringes and converged at the hospital conference room ‘to sit’.

This would be the situation until government pays them their protracted overtime allowances dating back to September last year. As to when government would pay them no one knows. However, in case it (government) decides to go to court to seek an interdict against the continuation of the strike then they (nurses) would have to abandon the strike in respect of that judgment. The nurses said because they were the essential services providers they knew for a fact that government would go to court to try and stop them from striking.

Meeting
They resolved this yesterday during their mass meeting at the Greater Alpha Restaurant, Manzini.
They were told that no one else but only their President Bheki Mamba would tell them when to go back to work and this would be only if government had either paid the money or went to court. Mamba explained to the over 300 nurses, who attended the meeting that they would have to respect a court order in the event government runs to court. “Once the court order is issued saying we must go back to work we will have no power to go against it and there is no argument on that,” he said.

Secretary General of the Swaziland Democratic Nurses Union (SWADNU) Sibusiso Lushaba told the nurses that shop stewards in the different regions would make logistics on where they (nurses) would be during the strike action.

He explained that it would be better for them to be at their work premises so that they could be monitored by their leaders while the national executive committee (NEC) monitored its progress at national level.

“We plead for cooperation from all the nurses in the different hospitals and clinics. This action is for a good cause, so, we need each other’s support to meet our goal. Without support we will not get our money,” he said.

This resolution came two days after the nurses were engaged in a protest march and delivered a petition on the allowances to the ministry of health. The two-day march was a fulfillment of a resolution taken by the nurses during their congress meeting held last month in Siteki. During the congress it was agreed that the nurses would take to the streets every week for two days (Monday and Tuesday).

Distributed
Yesterday it was revealed during the meeting that there were some few cheques that had already been distributed but the nurses were warned against taking them until all of them (nurses) received the money. While other nurses announced that the cheques were received others said they gathered that they were bouncing in the different banks because they were post dated.

Neither the Minister of Health Bennedict Xaba nor his Principal Secretary wanted to comment on the matter. They both said they did not have comments when contacted late in the afternoon yesterday.
However, by 6:30pm the minister was still in a meeting with NEC in his offices and it could not be gathered what transpired during that meeting.

Call for nation’s support in strike

NURSES have asked members of the public to support them in the strike action. Sibusiso Lushaba, Secretary General of the Swaziland Democratic Nurses Association (SWADNU), said the support could be by forcing government to pay them their money or demand answers on the situation.
He said through the strike action they were not trying to hurt them (patients) because they knew that they were innocent but were pushed to do this by the unfaithfulness of the government they voted for.
He said it was unfortunate that during such actions the innocent members of the public were greatly affected because they used government hospitals when sick as they could not afford the private hospitals’ fees. Lushaba said as nurses they understood the impact the strike would have on the public but they had no alternative because they were hungry.

He pleaded with the nation, mainly people who have sick relatives admitted in different hospitals to be patient as they (nurses) tried to ‘nurse’ the situation. “We have been patient for a long time now and during all this time, government has been promising us heaven and earth and when it is time to deliver, it fails. We cannot take it anymore. All that we as nurses want now is the money we deserve because we have worked for it,” he said.

In November last year government signed a collective agreement with the nurses that it would pay them their allowances in January but when the time for that came government asked them to be patient until the following month. In February government sang the same chorus.

NEC fails to convince nurses against strike

THE National Executive Committee (NEC) of the Swaziland Democratic Nurses Association (SWADNU) saw red when nurses blamed them for resolving they engage in a work to rule strike instead of a total shut down. Different nurses, about 10, who spoke after their President Bheki Mamba had announced this, stated clearly that the NEC was out of order in this regard.
The NEC took the resolution that they engage in the work to rule during a caucus meeting they held for over 30 minutes outside the conference room. Mamba explained to the nurses that they came to this resolution after putting into consideration that they were not demanding salary adjustments but overtime allowances.

“So, we noted that it would not be right for us to engage in a total shut-down as almost all of you want rather we not work the overtime. I would also ask that you give us time to tell our employer that we have engaged another gear which means that you will not start the strike action today or tomorrow as we have planned to meet government tomorrow,” he said.

The nurses shouted against that telling the NEC that it was either they engaged in a total shutdown or they went to work. They also ordered the NEC to tell government of their resolution immediately after the meeting because they were not ready for more government stunts. It was suggested that the nurses vote for what they wanted and almost all of them voted for the idea of the total shutdown while only two nurses suggested that they engage on the work to rule strike action.

The two nurses who raised their hands against the total shutdown were booed by the whole house.
This resulted in the NEC having no choice but to announce a total shut-down in all hospitals.
One of the nurses only identified as Ndzimandze, who was the first one to make submissions after the announcement of the NEC’s resolution, said the work to rule strike action was less effective compared to the complete shutdown.

My Swazi Reinvention

2011-03-15T11:21:00.000-07:00

After an amazing trip to India with Tini and Nick (hopefully will post about it soon) then a great month at home, I am back in the Kingdom of Swaziland. At the end of February I started my new position with ICAP, a Columbia University organization, as the clinical advisor for the Lubombo region.

Lubombo is the eastern region of Swaziland that borders Mozambique. In addition to myself, the regional ICAP team is composed of a nurse, an adherence and psychosocial support person and a data manager. We support the major hospital, Good Shepherd, and the health center, Sithobela as well as 14 of their feeder clinics. Our team provides technical assistance, systems strengthening and clinical mentoring/training in an effort to decentralize HIV care. We work closely with the Ministry of Health through the regional health management team to achieve this. About 80% of our time is spent in the clinics each month, providing clinical support/trainings as well as evaluating systems through observation and more quantitatively through quality improvement activities.

This is a significant change from my previous role at Baylor, which was more clinical focused. I am excited for the challenge and think I will learn a lot from this position. I definitely believe it gives me an opportunity to make a more sustainable impact.

As for the personal side, I am living in Siteki during the week. I have been staying with some friends who work for an Italian NGO, Cospe. I had initially planned on getting my own place, but for safety reasons have decided to stay put. Chiara, Emanuela and Stefano have been so gracious and welcoming. Now I just need to get a bed and start unpacking. Garrett's room is going to feel so empty once I move all my boxes that have been sitting in the corner of his room for the last three months! Siteki is a nice little town of about 20,000. It is even more quiet than Mbabane so I foresee most weekends I am in Swaziland being back in Mbabane. The best part of Siteki is the proximity to Mozambique, which I have not taken advantage of since being back. Worst part so far, mosquitos! The first mornings here I woke up with swollen eyes from mosquite bites. Since then I have not gone to bed without mosquite repellant. I am thinking a mosquite net might follow closely after my purchase of a bed.

3rd Annual Panorama Drive Thanksgiving Extravaganza

2010-12-22T04:00:00.000-08:00

Michelle has been the gracious host of Thanksgiving the last two years, but since she was leaving that next Monday, Steph and I offered our flat. It honestly will probably be the easiest Thanksgiving I ever host. Paisley actually did most of the pre-party hard work and Thobile did most of the post-party hard work.

Paisley came over early while we were at work (still not a holiday here) to start cooking the four turkeys and enjoy our amazing view. It was her first time and she nailed it. All the turkeys were cooked perfectly. She stepped back after the cooking though to let the men do the carving. Each had man had their own technique. The most critiqued was Nick's method of just pulling off the meat. Dan and Doug were a little bit more methodical in their carving. And suddenly our place was turned into a Thanksgiving wonderland complete with an NFL game on big screen (Thanks Tao and Alison). The table was stocked with all the typical Thanksgiving dishes, turkey, stuffing, mashed potatoes, green bean casserole, plus some bonus Taiwanese food, Ethiopian Injera, among other exotic dishes. We are estimating there were about 60 people who joined us to celebrate. All continents were represented except Antartica, unless you count Cooper who spent a month living there.
We tried our best to pass on the Thanksgiving tradition of eating until you feel like you are going to explode. Garrett here was demonstrating just how to fill your first, second and third plate during Thanksgiving. The fourth is saved for dessert!

Endless good-byes before new adventures

2010-12-21T10:16:00.000-08:00

The last two months has been full of good-byes. Everyone who knows me, knows that means it has been a hard time. I am sure it only means new adventures around the corner, but that's only a little consolation when you are in the moment. I will summarize briefly all the good-byes.

1. Pinkett Leaving Baylor

Pinkett was the nurse that I had worked with since starting at Baylor RFM. She was enthusiastic about caring for the children of Swaziland. She was always looking for ways to improve herself and the clinic in order to provide the best possible care we could. She really built the Baylor program at RFM. She should be happy to know that Sibanda and Siphi, the two current nurses, are as dedicated to maintaining the level of care as she was. While this was a hard good-bye for me, it was only a professional good-bye. Personally, Pinkett will always be a friend. Stephanie and I were lucky enough to join her husband and her for a nice lunch and afternoon last weekend.

2. Tini and Jenny's Simunye going away bash.

Each year, the sugar company at Simunye holds a fun fair. This essentially is a midwest county fair. Complete with scary half rusted rides,

games for kids and adults,

and even carnies.

Why would we go to what boils down to a county fair for a going away? Well, Freshly Ground was playing this year. For those who don't know Freshly Ground, they are a great South African band. They collaborated with Shakira for the World Cup theme song this year. I would strongly recommended checking out their music. The show as expected was great and we even got to hear "Waka waka" live!

There were only two mishaps for the weekend both occurring on Friday night. First, Tini getting stuck in the bathroom. Jenny valiantly climbed over the neighboring stall to lend a helping hand.

Tini meanwhile had found an escape route through the window...only to find the ground was a little bit further away than expected. While children gathered to point and laugh, a man came from nowhere with his arms extended saying, "trust me". Tini really had no choice so she did. Lowering herself down into the man's arms. When she turned back to thank the hero of the night, he was gone...just like a true super hero. Jenny,whom Tini had left in the stall, figured out how to open the door and walked out.

The second mishap happened on the drive to our lodge in Mlawula Nature Park. There are two entrances to this park joined by approximately 18 kilometers of gravel/rocky road. The fair was close to one entrance while the lodge was at the other end. So around 130 in the morning as we are carpooling back, Garrett's car, driven by a friend, hit a large rock busting a large hole in the oil pan (as we would later deduce). The car of course was almost exactly half way between the two entrances and undrivable. So we piled into other cars and left the car on the side of the road with the triangle warning sign.

The next day we arose early to try to sort the car. After about an hour of looking for a break down (tow truck) in Siteki (my soon to be home), we realize there is not one. Now our Swazi friend Tao had recommended a flat bed to get the car out of Mlawula because with a normal tow truck the bumper would be hitting all those same rocks. As we were trying to find one to come from Mbabane or Manzini, we happen to pass a government flat bed on the side of the road. We pull over as the driver comes out of the store where he was purchasing a drink. Nick and Garrett negotiate some assistance from the nice man and off Garrett and I go to collect his car. The tow truck was on his way from Siteki to Simunye to collect a police car.

After just a small detour to Mlawula, he was off to collect the police car. We then arranged for a regular break down to come from Mbabane to take the car to Paulino, our mechanic, who met the car and tow truck at his place.

Finally after spending the better part of the day sorting the car, we were able to enjoy the fair and concert. It was only later that I saw the pool and fun at Mlawula that we missed while dealing with the car. Needless to say, we all headed back to Mbabane that night after the concert instead of making the drive through Mlawula again.

3. Stephanie and Michelle's Malalotja good-bye
One of our favorite spots has always been the cabins at malalotja. We had more than thirty people staying over night. Now they have added this great new reception area with a restaurant and bar. This was the scene of Michelle and Steph's good-bye party. At the back by the bar, there are plastic curtains that roll up on a nice day. The staff allowed us to bring grills up to the back. It was a great setting for a party. They kept the bar open until ten for us. They even allowed us the use of their plates and cutlery. Don't worry the party did not end at ten. It just moved to the cabins.

The next day, we took a hike to the potholes, one our my favorite places in Swaziland although I was hurting that day. The best part of the potholes are the swimming holes and this was a perfect day to enjoy them. At the top potholes you get in by jumping. I had done this before, but was still hesitant. You can see I was a bit behind Garrett. Lily played in the pools, but didn't jump...next year I'm sure.
4. My RFM good-bye.
Don't even know what to say. This has been my family and my home for over two years now. I have gained so much from being there. I will miss the staff tremendously. They are so hard-working and truly want the best for our children.
Over the last two years, I have become a Swazi make, loving these children so much. The staff decided I needed to look the part. They added the fasionable scarf for a little bit of flare.
At RFM, I worked not only with the Baylor staff, but the RFM staff. This included the adult HIV clinic, the TB center, the pediatric department, the children's ward and virtually every other department at some point. Some of these departments also contributed and got me some Swaziland masks and these lovely jewelry boxes. I was welcome and made to feel a part of the family. I will miss this second home dearly.

But no doubt, what I will miss most is the child running out to throw their arms around me as I walk in the clinic, holding the babies or children on my lap while I write their refill, having a parent come to greet me and thank me for caring for their child, having a gogo, whose child we weren't able to save, come by just to say hi. I will always carry them in my heart and know that I am a better person for having gotten the chance to be a part of their lives.

More posting after I return from India. I will be in the states for almost a month before returning to Swaziland so will have fast internet and no more excuses!

Change is in the Air

2010-11-16T09:37:00.000-08:00

I know I have been extra bad at posting the last few months. I will go back in time and post about a few major events, but mainly I will just try to keep up from here on out.

As a lot of you know, I was scheduled to leave Swaziland at the end of October for a major 3 month trip to Thailand, Vietnam, Cambodia, Laos and India with my dear friend Tini. Well, Tini got an opportunity for a great job in London so decided to head back there at the end of her contract. She did negotiate about three weeks off around Christmas so we could still do the India part of our trip. That left me with two options (the way I saw it): 1. continue with the travel plans or 2. see if I could stay in my current post with Baylor for a bit. Luckily for me, Baylor agreed to allow me to stay with the team here in Swaziland until Christmas. As time always does, it has flown by. I now have just over four weeks remaining with the Baylor clinic. I think I am in denial. I have not even started saying good-bye to patients yet! There is a major turnover going on in Swaziland right now amongst the ex-pat crew. Tini, Jenny, and Fi and Jason left at the end of october. Michelle leaves in the next couple weeks and Steph will be heading back at Christmas. My plans, you ask? The definite plans: 3 weeks in India starting on December 22 then home to the US for a few weeks. After that? Well, I am looking at other opportunities that would allow me to stay in Swaziland for a bit longer. Nothing is definite , but it is looking more and more like I will be returning to the kingdom come February 2011. I will let everyone know once plans are more set in stone.

Girls Weekend

2010-10-04T11:06:00.001-07:00

In honor of King Sobhuza's birthday, Tini, Jenny, Ciara and I took a four day weekend and headed to the kalahari in Botswana. It was a fairly lengthy drive through South Africa to Botswana. Highlights along the way included the South African border town of Zeerust. Proving that we perhaps have been in Africa too long, as we drove through the booming metropolis of Zeerust, Tini exclaimed in all seriousness, "A two 'Chicken Lickin' and a 'Hungry Lion' (both cheap end fastfood restaurants), this town has EVERYTHING". The truck below also created an interesting converstation. It is hard to see it, but the white truck is a lead truck to the flatbed truck behind it. The sign on the roof says, "ABNORMAL", with two red flags on either side. I am not sure which is more politically correct "ABNORMAL" or the American "WIDE LOAD".

We finally arrived at Khutse Game Reserve to find we were the only four people booked at the Lodge. Despite this fact, our rooms were not ready yet. Luckily, we had stopped in Gaborone and purchased some of our own refreshments, including local Botswanan beer and ingredients for gin and tonics. Unfortunately, the drinks were all warm by the time we reached the lodge. Because there was no ice, we convinced them to let us put our drinks in one of the refrigerators behind the bar. They gave us our own little shelf and allowed us to go get our refreshments whenever we wanted to. Finally our rooms were ready and we went to have a shower/rest before dinner. Ciara came to visit Tini and I closing the door on her way out. We did not realize, until we were getting up for dinner half starved, that the door locks automatically. And, of course, the key was still on the outside from when the woman had shown us to our rooms. Tini and I were locked in the rondeval. This is when we realized it might not be a good idea for us to travel through Asia together. Our solution at that time was to get responsibility lessons from Michelle and Steph. Now, though, since we are only going to India we will be chaperoned by Tini's parents.

I saved the day by climbing out the window and freeing Tini. That night we had a personal dinner with over a 1:1 staff to customer ratio before retiring fairly early.

The next day we got up early to do a walk with a Sans Bushman. The had moved out from the Kalahari in the early 2000s leaving their traditions and nomadic life behind. According to our guide, the government offered homes, schools, clinics and cattle for those willing to move out. There have, however, been some legal suits saying the San were forced out of the Kalahari.

The walk was probably the most interesting part of the trip. We learned that during the dry season, the Bushmen used tubers for drinking/cooking water as well as bathing. It is amazing how much water can come from one potato.

We then watched as our guide made a fire with two sticks. He used a hard stick on a soft stick based twirling it back and forth to make ash.

He then used the hot ash to light grass making fire.

Our next lesson was how to make rope from a plant called "Mother-in-law's tongue", which looked somewhat similar to a green onion. He removed the outer green part leaving the inner fibers. He then separated and twisted the fibers together by rolling them along his leg. The rope he made that day was thin, but amazingly strong. It would be used to trap small animals with the setup shown below. The bait would be in the middle. As the prey came to feed the rope would snap up catching the prey. I am pretty sure I could survive a full three minutes in the middle of the Kalahari now.

After our tiring morning of fetching water, building fires, making rope and setting snares to catch our dinner, we did a bit of relaxing by the pool filling the afternoon with reading, napping and putting a puzzle together.

Later that afternoon we went on a game drive in the game reserve. The safari vehicle looked like any other from afar, but once in we realized the seats were old airplane seats with trays and all. The game was less than spectacular, but driving through the Kalahari was interesting. The amount of foliage was not what i expected from a desert.

The sunset over the Kalahari was beautiful. That night upon our request, dinner was moved under the stars around a camp fire. We spent hours enjoying the fire and chatting.

The next morning, we headed to Gaborone to check out the big city. On the way, we began to believe the guidebook when it said there are more donkeys in Botswana then people. This cart was not driving itself, the boys had just jumped down to ask for treats from us.

We had one stop on our way to Gaborone in my favorite town, Molepolole. We had assumed that Khutse being a large tourist lodge would accept credit cards so we had not brough enough Pula to cover the two nights. The staff, being very trustful, arranged for us to meet someone in Molepolole to pay. Again, we thought we would be able to pay in credit, but not so. After about eight trips to different ATMs we were able to get out enough cash to pay for the lodge. We then pulled off a shady transaction in the parking lot of a grocery store handing over a large sum of Pula to a lodge employee. I was a little nervous for her carrying so much money. Luckily, she was accompanied by some male family members.

That night in Gaborone, we enjoyed a movie before meeting some of the Baylor Botswana doctors for a wonderful Brazilian dinner.

It's Always Different When It Is Your Child

2010-10-03T11:30:00.000-07:00

On July 18th, a group of us headed to Johannesburg for Asher Raymond Epstein's bris. The bris was held at the beautiful house in Joburg that Jessi and Uri were renting for the first three months of Asher's life. Both sets of grandparents were able to be present and had brought with them a tini little kippah for Asher to wear. The ceremony was performed by a mohel team consisting of a surgeon and a rabbi. The procedure was much more medical than I expected with a large sterile surgical field set up. Grandpa Greene comforted Asher during the circumsicion. After the procedure the Rabbi performed more blessings and naming ceremony. Asher means happiness in Hebrew. After the naming ceremony, Uri's mother made a small toast. At Uri's bris, the family had opened a bottle of brandy for a toast. The brandy was saved and used for toasts at Uri's Bar Mitzvah and his wedding. A toast was again made with Uri's brandy and a new bottle was opened for Asher. Jessi, who works for PSI in Swaziland scaling up the circumsicion program, quickly realized that everything is different when your child is involved and was quite ready to have a drink of the brandy after the circumsicion.After a little love from his parents, Asher quickly recovered from the shock of the morning glad that this day can only happen once!

No pill, No scuba diving

2010-10-03T10:25:00.000-07:00

In early July we made a trip to the beach in Sodwana Bay, South Africa to escape the Swazi winter. For the majority of people, scuba diving was the major activity. Scuba diving has now officially transitioned from a stressful activity to an enjoyable one for me. I have become quite comfortable with routine. I can set up my equipment without a problem.

I have improved slightly getting my wet suit on without completely tearing up the skin on my knuckles.

I can locate my equipment on the boat to make sure I am situated in the most convenient place for when it is time to gear up out on the water.

I can pretend to help push the boat out. And I can conserve enough air that I can make it through the entire dive. You might chalk this up to having more practice, and I am sure that plays a part, but I know the real difference has been my discovery of the magic little white pill that keeps me from vomiting. The captain of the boat actually remembered me from last time and tried to convince the lady that I should take two. One is enough though. What an amazing difference it makes to not be hung over the side of the boat the entire ride!

While we were diving, Garrett, Shaun and Doug went surfing. While all this physical activity was great and all, everybody knows that the best part of beach trips are the naps!

Nothing says American Pride like South African bought paraphenalia

2010-10-03T09:10:00.001-07:00

This year our new neighbors, Joe and Garrett, hosted our Fourth of July celebration. It was quite an authentic American celebration. There were chicken wings on the grill (normally called a braii here except for on American Independance Day). There were games, including corn hole and some very serious paddle ball competitions.

Garrett hung an American flag outside the house just as my father always does.

Thanks to the World Cup, stars and stripes paraphenalia was rampant. There were even fireworks from the Chinese shop in town.

The amazing backdrop though was pure Swazi.

Where are you watching the game?

2010-09-12T07:48:00.000-07:00

This was the question asked almost every day from 11 June 2010 to 11 July 2010. Never "Are you watching the game?" because that was not even a question. The World Cup was too big of an event. Even non-soccer fans were routinely gathering to watch the games.

We kicked the world cup off at Dr. Hailu's, our executive director, house for the opening match featuring Bafana Bafana (South Africa) against Mexico. The pro Bafana Bafana crowd was tense from the beginning and only made more so when the announcers stated that no hosting team had ever lost the opening match. Note in the picture below Sandra's, our secretary, little girl on the left of the picture.

The crowd instantly went crazy when Tshabalala scored the first point of the World Cup. Unfortunately, Sandra's daughter was not expecting the celebration so was scared by the sudden move from sitting to jumping up and down screaming. She ended up in tears on her mom's lap.

Dr. Hailu, being the ultimate host, watched part of the game with Clinton Simelane, our finance director, through the window to allow his guests to have the best seats in the house.
We closed opening day at Tini's house. Tini's house was a regular viewing place since she is one of two of our close friends who actually has satellite tv. We took turns making main dishes that could serve large numbers. i made my family's famous chili, which was a hit!

The other regular house venue was Jessie and Uri, who had actually already left for Jo'burg to have their baby. Luckily, Uri's cousin Micah was working with Baylor for the month so we still had access to the house. There have been a number of parties at their house in the couple months they have been gone.

Other common game viewing locations included the Old Barn, The Green Room, the Mbabane club, the Mediterranean and Malendelas. The outdoor screen at Malendela's is where we chose to watch the Ghana-Uruguay game. Needless to say, the crowd was quite somber after Uruguay won the game by cheating! The lonliest game I watched was USA-Algeria. This is because it was a four o'clock week day game so I was in Manzini. Thanks to Lucia, I was able to sneak out early and I made it to Malendela's about 10 minutes into the game. Unfortunately, because the game was the same time as the England game, it was showing in the "chapel" at Malendelas instead of the bar. So I saw alone in the chapel watching the painful game listening to the English fans cheering from the bar as England went ahead. I only got the occasional person poking their head in to see the score. With the last minute goal though, I was the only one left excited since it meant that the USA took first in their group. For the final, a large group gathered at the Action Against Hunger house because their current director is from Spain. They had a great setup with the projector so the game was almost lifesize.
The game ended with joy from Arantza. For the rest of us, I think the end of the match was a mixture of sadness and relief. For the previous month, every night after work had been consumed by soccer so it was nice to be able to get back to previous activities. On the other hand, though, for the two years since I had arrived in Swaziland, the anticipation of the World Cup had been buidling and then suddenly it was over. Now we will just have to look forward to the Brazil 2014 reunion!

Spring is in the Air

2010-09-07T10:44:00.001-07:00

And people in my part of Southern Africa are getting spring fever. For the past three weeks, all public servants in South Africa went on strike for a pay increase. The union was demanding 8.6% increase while the government only wanted to concede 7%, which I would like to note is still above inflation. This included all teachers, border posts, many administrative jobs, transport and nurses. I like to think my job is important, but in truth without support staff a doctor is nothing. Most of the supporting staff, including janitorial staff, accountants, kitchen staff, of public hospitals walked out for three weeks leaving doctors. We spoke with a friend of ours who works in a public hospital in the Eastern Cape and she said she felt like it was like a war zone. Doctors were performing surgery without assistance. They were changing the bed sheets in the intensive care unit. But the sterile equipment and clean linens only went so far then there was noone to clean them. The military sent army medics and employees to cover larger hospitals. Community members were coming to help wash linen and cook food, but I am sure many unnecessary deaths occured over the last three weeks. The strike ended today, but without an agreement. Hopefully, they are not back on the streets again soon.

Then last week in our neighbor to the East riots broke out over the increasing price of food and energy prices. Ten people died in three days of clashes between police and rioters. My friend, Paisley, was in the Maputo for a conference. She said the city shutdown from Tuesday on with everything, including our favorite Thai and gelato places, closed. She was confined to her hotel for the next three days. Finally on Friday, she and a group of others received armed escorts to the airport and she flew safely to Johannesburg. The food increase is said to be due to the Russian bans on wheat exports due to droughts. Things seemed to have calmed in Mozambique, but needless to say we rescheduled our weekend trip there.

Finally, here at home in Swaziland labor strikes started yesterday. The labor strikes include the Teachers' Association and Swaziland Federation of Trade Union. They have been peaceful, but five members of COSATU, Congress of South African Trade Union, were arrested yesterday. They were detained briefly and then voluntarily returned to South Africa. It is still not clear to me the goal of the strike, which could be a problem if the government also does not know, but a piece of me is glad that Swazi people are at least trying to be proactive in regards to their rights. Perhaps a little bit more planning and strategy could help in the future.

Adapt or Die

2010-08-28T15:09:00.000-07:00

On the way from the USA-Ghana game in Rustenburg to the Argentina-Mexico game in Johannesburg, Michelle, Steph, Garrett and I decided to make a stop at the Cradle of Humankind. The Cradle of Humankind is a World Heritage Site close to 180 square miles. The site has produced a large number of some of the oldest hominid fossils. We visited the network of limestone caves called Sterkfontein Caves, where the 2.3 million year old fossil Australopithecus africanus, "Mrs Ples", was found. Sterkfontein has produced nearly a third of the hominid fossils ever found.

Of course, pictures do not do the caves justice. One of my favorite rooms in the cave was named "Elephant cave" because of a large formation that truly did look like an elephant. You will have to look hard and use your imagination to see it in these pictures. The first picture is only of the bottom of the trunk and the two ears. This black and white photo shoes most of the elephant. He is standing to the right of the picture. If you look closely you can make out the trunk, two ears and the front legs. The elephant also had hind legs, but it was too large to get the whole thing in one picture. We had a great guide who not only gave us a good history of the caves and discoveries made there, but also the saying that is going to be on our 2010 Swaziland shirts.

If you have been a faithful blog follower, you will remember that in 2009 our shirts said, "I'm a winner" on the front and "I survived Swaz 2009" on the back. This year the front will say, "Adapt or Die".

Waka Waka

2010-08-28T12:09:00.001-07:00

Four days after I swore off attending any more World Cup games, we were back in the car to Rustenburg to catch USA-Ghana. This was a very last minute decision after the US beat Algeria. We decided to buy official tickets, even though it meant we would probably pay more, so we would not have to stress about scalping tickets once we reached Rustenburg. We did not, however, have a place to stay before we left. Not convinced we could find an open room in Rustenburg, I had written down many guesthouses in the area and thrown the tent into the trunk, just in case. Garrett and I were the first to leave Swaziland. Just into South Africa we passed a car that ourwardly exemplified our excitement for the World Cup. As soon as we crossed the border, Garrett started calling for hotels. He started with the hotels in the Lonely Planet and after only a couple of trys found one with availabilities for about $45 dollars a night. We snatched it up and were really excited, assuming that if it was in the Lonely Plant it could not be too bad. I began to doubt this logic though as we approached the hotel. We arrived in the middle of the afternoon on a Saturday and the street was deserted. It was like a ghost town.

We finally found the hotel and went inside to check in. The hotel was quite large and probably the place to stay...in the 70s. Now, however, in 2010, the hotel attendant sits behind bars with a sign next to the window that says, "No hourly rates". Still feeling this was a better option than camping in the cold, we proceeded to check in. I was not necesarrily concerned for our safety, but I was quite concerned about the safety of our 1998 Toyota Corolla, Lacy. When I asked the woman if the car was safe, she told me to park it directly in front of the hotel because they had a guard who started at 5 pm and worked until the morning. She also warned us not to go for a walk, but if we wanted to walk we should go to the left, not the right. As we were reassuring her we had no plans of strolling around the neighborhood, a gentleman came down the stairs followed by a woman. He discreetly handed a key to her and received, in return, his 100 Rand key deposit. It seemed a bit fishy that this "couple" was checking out at 4 pm in the afternoon without any luggage, but the sign assured us there were no hourly rates so I am assuming they had accidentally "slept" through check out time. In the end, not only did Michelle, Steph, Garrett and I stay at the lovely Cashane hotel, but two other friends, Amanda and Brian, also decided that a roof was better than none. You better believe this hotel made more money in July 2010 than it has since 1980.

Among all its amazing qualities, my favorite part of the Cashane Hotel was the "Ladies Bar".

The crew gathered in the Ladies Bar for a refreshment prior to heading to the game. Surprisingly, Steph, Amanda, Michelle and I quadrupled the number of "ladies" in the bar. It was obvious the bar had not been redone since the 70s, but it was playing music from the 80s so they are trying to be a little bit more contemporary. There we met our Ghanaian neighbors and exchanged some friendly banter.

We did, eventually, manage to pull ourselves away from the Ladies Bar to head to the game. The game was a rollercoaster of emotion. Ghana scored in the opening minutes, in fact, we were still in line for our Budweisers when they scored. We did manage to equalize sending the game into overtime and it seemed that the momentum was with the USA. Again, though, Ghana scored quickly in extra time and the game was over. Michelle, Steph and I had bitter sweet emotions regarding the outcome. We were sad the US lost, but glad that if we had to lose it was to Ghana, the final remaining African team. We even joined a group of Ghana fans outside the stadium in an impromptu dance celebration. Garrett, on the other hand, was just bitter that the US had lost. He was not getting any consolation from the fact that an African team was still in the World Cup. He grumbled all the next day, until our waiter in Jo'burg said casually, "Well, you cannot argue with Mother Africa". It seems quite cheesy now, but it did finally bring Garrett to our side.

After that dinner, we attended our last World Cup game. The game was at Soccer City, which was the new stadium that Johannesburg had built to hold the opening game and finals. The stadium was amazing.

The stadium can hold 90,000 people and has a great vibe. Our seats were pretty high, but still gave us a good vantage point for the game. The match we watched was Argentina versus Mexico. Being good neighbors, we were in full support of Mexico. The Argentinian fans, though, in my eyes should have won the "Fans of the World Cup" award. If there is not one, there should be one created for them. Every game I went to there were Argentinian fans with flags running around the stadium, but when you got them all together it was a mad house. During the introductions and continuing into the beginning of the game, they littered the field with toilet paper. The amusing thing was that there was noone to pick up the toilet paper so the Argentinian goalie himself had to come out to clear the field. Argentina won the game pretty handily. That night we drove half way back to Swaziland. We reached our accomodation about 1 am and left at 5 am to make it back for a full Monday of work. I had not been so tired since residency! This time I was truly done with attending World Cup games.

Ayoba!

2010-08-23T11:37:00.000-07:00

While I do believe that the USA-England game overall was the highlight of my World Cup experience, each game was exciting for different reasons. I will try to give the highlights of my remaining five games.

1. USA vs Slovenia- Friday, June 18 in Johannesburg

This game had the highest ex-pat turn out from Swaziland. It is a challenge to come up with five people that I know here that were not at this game.

The game was at Ellis Park in Johannesburg. Unlike Rustenburg from the previous weekend, this is one of the larger stadiums with a capacity around 70,000.

Each of the stadiums had a suspended robot camera, which if you watched on tv was your view of the game.

After it took us three hours to get back to our car after the first game, we decided it might be wiser to use one of the Park and Walks so that we were not reliant on one of the buses. The route from the parking lot to the stadium took us through some neighborhoods. The locals were lining the sides of the street taking in the excitement. It did almost feel like a local parade with everyone dressed up.

Just outside the stadium, we were approached by a guy offering to paint faces. I quickly accepted without asking many questions. Steph and I before the face painting. In the process of getting my face painted.

It was only at this point, that I realized I was having an American flag painted on my face by an Argentinian man. And finally, the final product. Now I loved the final product. Anyone can paint an American flag on a face, but only a random dreaded Argentian man could make it backwards and more than just a little scary. I proudly wore it all night including once we left the game for the fan parks later that night, despite some hefty discouragement by some members of our group. But I told Joe, if he was going to whip these dance moves out in public then I could wear my face paint.

While I was getting my face painted, other members of our crew, again with Cooper in his American flag suit, got interviewed by Al Jazeera.
For those of you who did not follow the World Cup, this was probably the most exciting football match that I saw. The Slovenia team came out strong and led 2-0 at half time. We were fairly dejected, but I did remind Michelle about the last game we had watched at Ellis Park, the confederation cup finals between USA and Brazil. During this game, the USA led 2-0 at half, but Brazil went on to win the game 3-2. We were hoping for a repeat comeback. And thanks to Donovan we were not disappointed. He booted in the first goal followed by the tying goal by Bradley. Then the winning goal came when Donovan connected with Edu on a free kick. The stadium, which predominately American fans, went crazy.

For about five minutes, before realizing that a foul had been called and the goal was called back. Despite this, the game still ended with momentum for the American team. It was a rough game for all of us. I personally went home with these battle scars.

I decided during the World Cup that there are different types of fans. These bruises should tell you exactly what kind of fan I am. I am a jumper. Every time I jumped up and down out of excitement, I would hit the back of my legs on the chair. There was obviously a lot of excited jumping during the second half!

After the game, we went to the fan park to watch the England-Algeria game. After the nil-nil draw, Jenny was ready to trade in her English heritage to be an American. They all come to the good side eventually.

2. Cameroon vs Denmark- Saturday, June 19 in PretoriaNot quite the outcome we were hoping for this night, but a great atmosphere. The stadium, other than a handful of Danes, were all pulling for Cameroon. Africa definitely united during the World Cup.

I am pretty sure the majority of the stadium was rooting for Cameroon out of a sense of African pride, but there were definitely some true Indomitable Lion fans.

3. Italy vs New Zealand -Sunday, June 20 in Nelspruit

This was a spur of the moment game for me. I decided Sunday morning when I woke up that I would like to see another game. I knew that Tini, Nick, Tao and Shaun were driving down from Johannesburg to Nelspruit for this game. So I called them up to see if I could hitch a ride to Nelspruit. I started to get a bit nervous about finding a ticket to buy when I realized that we were going to be late for the game. I was convinced I was going to be sitting outside the stadium waiting for them to come out. Just as we sat down on the bus from the parking lot to the stadium, I hear the guy behind me say he was selling one ticket. When I asked how much he said 500R. This is about what our friends had been buying scalped tickets for, but I tried to talk him down a bit. He refused though explaining that is was a category 1 ticket that was going for$160. Afraid I would not find anything else, I snatched it up. I initially had thought I would try to find a seat by the rest of the crew, but once I realized I had a category 1 ticket I decided maybe sitting alone would not be so bad. After I bought the ticket though, Nick put it into my head that it might be a fake. I was never more nervous putting my ticket into the scan machine. Luckily it worked! Turned out the gentleman who sold me the ticket was an employee of one of the major South African banks.

This was one of the tickets they had bought for their employees. This explained why he was willing to settle for so much less than face value. So it worked out great for both of us. He made a little free money and I got the best seats I had for any World Cup game for cheap! The seats were fourteen rows up just to the left of midfield. This picture was taken without any zoom.
I was really glad I went, not because of the soccer game because it was relatively boring, but for the stadium. The major support beams of the structure were designed to look like giraffes. Unfortunately I did not get a great picture, but you can get an idea from the pictures below.

We got back into Mbabane at about 8:45 on Sunday night just in time to watch the late game, Brazil v Ivory Coast. I was barely in bed before I fell asleep that night. When my alarm went off Monday morning, I swore I would not do any more World Cup games....until the next weekend anyway.

Why is Swaziland so far behind in the fight against HIV/AIDS?

2010-08-19T10:02:00.000-07:00

An article in the Swazi Times from a respected member of the royal family and an advisor to the king.

http://www.times.co.sz/index.php?news=19735

Death

2010-08-04T11:24:00.001-07:00

That's right. There is no sugar coating of this post. Having worked in Swaziland for two years now, I have developed a number of coping mechanisms to deal with the amount of need, illness and death that I see on a daily basis at the clinic. Sometimes, though, reality slaps you in the face. Today was one of those days for me.

Last week, we reviewed our data and realized we had had 15 deaths in the last two months. In my year and a half at RFM we have had from 1-5 deaths a month. Not only was it the number of deaths though that was alarming, but also the population. In an HIV program, you expect to have high mortality in the first few months of treatment. Recently, though, we have seen a large number of previously stable patients dying. Based on these changes, we decided to do a mortality review. We are only partly through the review of the files, but preliminarily about 66% of patients we reviewed were measles complications. The majority of these had been on HIV treatment and doing well prior to the measles. Another handful we believe was related to drug resistant TB. I learned in medical school about measles and TB, but given how rare these diseases are in the US you underestimate the seriousness of them. Here the normal morbidity and mortality that these diseases cause is only amplified by the HIV coinfection.

Another common comorbidity we see with HIV is malnutrition. We have two ways to treat malnutrition in Swaziland. One is a peanut based outpatient therapeutic feed. The patient goes home with a certain number of packets of a very sweet peanut butter to eat. The number is based on their weight and degree of malnutrition. If there are other complications (vomiting, diarrhea, fever) or the patient has failed therapy at home, then they get admitted for inpatient rehabilitation with a special milk. RFM has an inpatient program. Before we moved to our new clinic, we were spending a lot of time in the children's wards with the malnutrition and TB patients as a main focus. This is because malnutrition, TB and HIV often go hand in hand here. We had worked hard to mentor the doctors and establish testing on the wards. As our clinic became more busy, we had to step out of the wards. For the last few months, we have taken on more of a consulting role for the known HIV positive patients or complicated patients. I think I have been tricking myself into thinking that things are going well on the wards. Today, though, Action Against Hunger, a French NGO, visited RFM to go over the nutrition data for the hospital. I unfortunately was busy, but my colleague brought me back the data. Since January 2010 there has been a drastic increase in the death of our malnourished children and a decrease in the cure rate. It is a pretty dramatic change from the 2009 data. Also, over half of the children had an unknown HIV status, which is devastating to me. I am sure there are many factors contributing to these worse outcomes, but I have realized I cannot ignore it. This trend is unacceptable and I feel a responsibility to help the team figure out how we can turn this around.

All of this was compounded by the death of a baby today whose mother I had become quite attached to. I met the mother in February when she came to us pregnant. She started on the ARV therapy to try to prevent the baby from getting HIV. This was successful. The baby was HIV negative, but after delivery was diagnosed clinically by our former medical director with a rare syndrome called Edwards syndrome. This syndrome is caused by an extra chromosome and is fatal with the majority of children, even in the developed world, dying before their first birthday. The mom is a very bright woman, who on her first visit recited for me everything Dr. Joyce had told her. She on an intellectual level understood the prognosis for the baby. The baby was having trouble gaining weight, but otherwise every time I saw mom was doing ok. She was taking amazing care of him and obviously loved him with her whole heart. Today, she brought him in sick. I knew immediately that he was critically ill. I believe that he had a defect in his heart related to the Edward's syndrome that was doing just enough to sustain his normal life of eating, sleeping, smiling, cooing at mom. It was just too weak to handle any extra stressors, including illness. Realizing that he was dying and knowing his overall prognosis, I gave mom the options of being admitted to the hospital or going home and trying to keep him comfortable. She opted to have him admitted. She is a very young mom and was understandably scared. She said, "I cannot take him home". She initially wanted to have him admitted at the hospital where he was born, but I convinced her he was too sick for the 1 1/2 drive in a bus. She agreed to stay at RFM and I called the wards to see if I could bring him over immediately to get oxygen started. When I got back into the room, he was gasping. I took him from mom to our first triage room for oxygen. I thought he was going to die in my arms, but the oxygen did seem to make him more comfortable and improved his color. I again gave mom the option of holding him in that room with the oxygen or admitting him. She just kept saying, "I knew this was coming, but this is too soon". So we admitted him to the hospital and tried what we could, but he died at four o'clock this afternoon. His mother was devastated and alone. I had called the grandmother and spoken to her boss in order to get her to the hospital, but she unfortunately did not arrive until after he had died. The final straw for me though was that there was no place for this mother to grieve alone because the room that is normally used for such purposes already had another grieving mother in it. We finally got her set up in a room we call the "dark room" so that she could hold him. I stayed until the grandmother came. As I was leaving, I gave her a hug and she told me not to change. I walked out of the wards and the tears came. This is only the second time since coming that I have cried. While I was obviously touched by this particular mother and child, the tears were really for all the women and children of Swaziland who face so much suffering in their lives. I just keep hoping against hope that we will soon see a light at the end of the tunnel.

I've got the fever and it's not malaria

2010-08-01T10:47:00.000-07:00

I went into the World Cup with tickets to two games. I ended up catching World Cup fever and seeing six games. Each game provided a unique experience and I enjoyed each for different reasons, but my favorite game overall was my first, USA versus England. For this reason, the game is going to get it's own (very long) post. The majority of the other games, I will lump into one post.

The night before, along with the whole of South Africa, we celebrated the opening of the world cup with South Africa's draw against Mexico. The day of the match, I was excited to get my hair cut and watch the US-England game with all our expat friends. That is until I got a text from my friend, Tao, asking if I was interested in a ticket. It seems to me that there is only one possible answer...YES!!!!! The problem was though that I had just gotten on the highway to drop some people in Manzini for the teen support group. It was going to be at least 60 minutes before I could get back to Mbabane and Tao's car was leaving. Luckily, Nick and Tini were willing to wait for me to get back. So I sped back, threw some stuff into a bag, grabbed my shoes and sleeping bag. When Tini came in to get me, I was standing at the top of my stairs with my arms full of stuff and a huge stupid smile on my face. She compared me to a kid going to summer camp and that is exactly the excitement I felt. Our crew met up with Tao, Alison and Garrett in Johannesburg where we were going to be spending the night at some family friends of Taos. In order to avoid taking two cars, we all jumped into Alison's Rav 4. Since there were six of us, this meant one person in the back, which on the way there was Tini.

When we arrive in Rustenburg, we meet up with another group of Swazi ex-pats at the Park and Ride. We have all been anxiously awaiting the unveiling of our friend Cooper's American flag suit. We had been hearing for months about this custom made masterpiece and it was finally time to experience it. The suit was spectacular, but my favorite part was the George W. Bush era t-shirt underneat with the slogan, "These colors don't run". Cooper was a popular man that night posing for many pictures. Cooper was not the only one among our group displaying some American pride that night. Our English friend, Tini, also seemed to be taken with the stars and stripes as she was caught not once....Not twice...

But THREE times with the USA Vuvuzela in hand. She was not the only English person though to be taken by the USA vuvuzela. I also received unsolicited vuvzela lessons from this random English man. When I first saw this picture, I hoped that the expression I had on my face was just a matter of catching me surprised, but in reviewing the picture documentation of the night I seem to have had that expression often. How have I gotten so far in my life without realizing that I make this face so often? How have you, as friends and family, continued to allow this to happen?

After spending some time tailgating, as any respectable American should, we boarded the bus, which was full vuvuzelas, chants and even a rendition of "Take me home, Country Roads". Because this was the first game in Rustenburg, some of the traffic logistics had not been thought through fully so the buses were sitting in the same traffic as the rest of the people trying to get to the game. Finally, excitement got the better of us and we got out of the bus to walk. The streets were crazy. They were full of dressed up fans, salesman with their goods laid out on the sidewalks, and South Africans just enjoying the spectacle.

After just a short walk, we get to the stadium. We are about two hours early for the game, but decide to head in to get some food, drink and enjoy the atmosphere. In a twist that sealed the fate of the night, the food lines were ridiculously long while the beer line was quite reasonable. We were taken aback when we realized that the only beer available was Budweiser, which I have never seen in Africa. This Englishman was not excited about it, but realized he did not have much of a choice.
After making our purchases we walked the grounds admiring all the patriotic outfits. Here is just a small taste. I am not sure the significance of the guy in the blow up costume, but Tini seemed amused. We did finally make it to our seats to watch some soccer. Garrett and I were seated next to a father and his daughter who had driven from Johannesburg to see the match. At home, I would not think twice about this, but it is rare to see father with their children here especially daughters. It made me quite happy to see and reminded me of going to American football games with my dad. Behind us, was this cute little boy with his vuvuzela, which was larger than he was.On the side is written, "This is my year". Hopefully, this kid has at least a little bit still to come after 2010.

As everyone knows, the game ended in a 1-1 draw, which for the US was pretty much a victory. The team thanked the crowd at the end of the game, but this was only the beginning of our groups adventures. After leaving the stadium, we headed back the way we had come from. When we got to the street though, all the buses seemed full and there was no clear pick up spot. So we decided to walk. As we are walking a long we come across a shebeen. Alison, our designated driver, wanted a coke so we all obliged. As we approach we realize there is not only drinks at the shebeen, but they have set a dj outside and a dance party has formed. Seeing that they were going to lose Tini and I quickly, we agree to meet back at the street in ten minutes. Unfortunately the pictures did not turn out great, but this was one of my favorite parts of the night.

They finally managed to extricate us from the dance party and we continue on our way. We finally reach a corner where there is a police officer so we ask directions to the park and ride. She advises us that we could turn left toward the park and ride or continue straight and get lost and mugged. We turned left. Along this road, we then run into an Afrikaaner family braiing on the side of the road. The husband was determined to give us a taste of South Africa. He insisted on exchanging our warm shebeen beer for cold beer. He also really wanted us to try Boerwurst, which he explained was a South African sausage. He did not ever get that Tao actually has a South African passport or that the rest of us live in Southern Africa, but his hospitality was unbeatable. We finally left the braii and just a short way down the road found a bus to take us to the park and ride. When we looked up the stadium was just ahead of us. Turns out we had walked in a big C from the stadium. We made it back to the car about 1 am, a mere 2 1/2 hours after the end of the game. It was only after attending another game at the same stadium that I realized we had gone in the completely wrong direction initially for the bus queue. Imagine though if we had gone the correct way we would not have happened upon the shebeen or the impromptu Afrikaaner braii. Alison was the hero of the night for then driving us all back to the Johannesburg. We all fell into bed about 3:30.

This picture is one of my all time favorites because in my eyes it sums up the night perfectly. You cannot fake those smiles, but the best part is that if you look in the background the entire stadium was empty. The game was long over. I am not sure why we were still in the stadium, but we were obviously enjoying it.

The next day over lunch, we watched the replay of the game. As you can tell we were all quite intent on the game, it was almost like we hadn't seen it before!

Joe Sleeps Like a King

2010-07-31T01:56:00.000-07:00

Joe, a Fulbright scholar, had a dream of camping in a cave on the top of Sibebe, the largest granite face in the world, so he planned the adventure as his last weekend in Swaziland. The crazy thing is that he got about 25 of us to agree to this in the dead of winter. So on Saturday, two trucks went up the mountain with all of our stuff, while we climbed up the face of Sibebe. This climb is not so much a leisurely hike, but a really steep stairmaster. It is so steep it is hard to stop to rest so you try to power through until your legs start shaking and you have to stop. Also, since I am not the biggest fan of heights stopping only meant realizing just how far down the ground was!The view from the top is amazing, but I am still not fully convinced it's worth it!

After reaching the top we climbed over the peak to the valley behind the peak, where the cave was. We rushed against the setting sun to get camp set up. Joe was convinced that if we built a fire in the cave, it would heat the walls and create a nice cozy environment. His goal was for the fire to be as tall as he is. They did get a fire going and it did actually heat the entire cave, but it never reached Joe's height. Surprisingly, to everyone except maybe Joe, it was quite pleasant sitting around the fire in the cave. We hung out for hours at the fire, talking, playing games, braiing, making Swazi s'mores. Some attempted a nighttime game of frisbee with left over glow necklaces from Bushfire, but it didn't last too long.

Eventually everyone split off to get some sleep. The majority of people had tents, but a few did not. They had brought sleeping bags and blankets to sleep in the cave. Matt and Farrell were among those sleeping in the cave and had packed a good North Face sleeping bag. Unfortunately, it was missing when they were trying to set up their camp. Matt looked everywhere unsuccessfully. Luckily there were enough extra blankets that they were able to borrow some. I was in a tent in a sleeping bag, but everyone who slept in the cave said it was actually not bad.

The next morning we were all sitting around the fire drinking coffee and tea, when Joe came out of his tent stretching and commenting on how well he had slept. Turns out because some decided to sleep in the cave, Joe had a five person tent all to himself. Later, we also discovered that on accident Shaun had put Matt's sleeping bag in Joe's tent. So while people were sleeping on the ground in the cave, Joe was cozy and warm in a North Face sleeping bag on a camping bed in a huge tent all by himself. So Joe not only got his dream of camping on Sibebe, but also a better night's rest than he had had in a while!

Mo Fire!

2010-07-27T08:57:00.000-07:00

Bushfire is a much anticipated event every year. This is not only because of the great music that comes through Swaziland, but all the fresh faces, both known and unknown, that it brings. Each year, the ex-pat spare beds, couches and floors are full of friends/acquaintances from Mozambique, South Africa, Lesotho, Botswana, etc. This year we hosted some of our Baylor colleagues from Lesotho. The concert itself only seems to be gaining in popularity. This year the line-up included the Parlotones, Freshly Ground, Lira, the Black Jacks, and, of course, Swazi's own Bholoja. This year I think I was so busy enjoying people and music that I forgot to take many pictures. I only have a few random pictures. Including a great one of Tini and our friend Shaun, who is doing a fulbright and volunteering for an organization called Young Heroes. Young Heroes was the recipient of some of the funds raised by Bushfire. It is a program operated by the country's National Emergency Response Council on HIV/AIDs (NERCHA) that supports orphaned and vulnerable children in the community with food, clothing, school fees, etc. It is a great program. Here is the web address if you are interested in learning more or donating: http://www.youngheroes.org.sz/.

All weekend they were selling these light up devil's ears. I love this picture...if only it were not blurry.
And that's all the pictures I have that are worth posting. I am still hoping to get a picture of the RFM contingent, Matt, Pinkett and myself. We had scheduled a clinic "meeting" Saturday evening. As I am sure you can guess it was quite productive. We finally concluded the meeting at the late night dance party in the crop circle created in the sugar cane fields.

I did have a pretty unforgettable experience unrelated to the concert on Saturday night. As Garrett and I were leaving the drinks tent, a woman grabbed my arm and said, "you're a doctor, right?" When I responded yes, she said, "you saved my baby's life last year in Hlatikhulu". I was speechless, but as she went on to explain the story it all came back to me. I was filling in for one of the other doctors in our satellite clinic, which is in a fairly rural area of Swaziland. I had just finished rounding on the children admitted in the hospital, when the nurses asked me if I could see a sick child who had just been admitted a few hours earlier. I got the history from mother of green vomiting (a not good sign of obstruction) for a day or so. When I examined the child, his abdomen was very distended and tense worrying me for a surgical issue. Upon further examination he had a large mass in his scrotal region. When asked, Mom said this had been there off and on since he was born, but had not gone down for the last couple of days. As you have all probably guessed without a doctor's training, the child had a congenital inguinal hernia. The problems though were caused because his bowel was caught in the hernia. This was causing his bowels to be obstructed, but more importantly was cutting off blood supply to his bowel, which could lead to death of the bowel. This is a surgical emergency. When I realized this, I called the doctor, who was actually supposed to be covering the ward, and explained that this baby needed surgery. The only option was to transfer the child to Mbabane government so the doctor came and completed the transfer. So in truth, I did not save the child. In fact, I did none of the work. I did not actually transfer the child or perform the surgery, but it felt pretty amazing to realize this mom truly believed I had. I have been thanked by patients before, but it was a whole different feeling to receive such positive feedback at a moment I was least expecting it. Based on Garrett's response to this event, I also realized that this might be ingenious pick-up strategy. I am still working on the details of how to plant seemingly random people throughout my life so they can pop out at opportune times to spout my virtues.

Swaziland expats spend 50 weeks a year waiting impatiently for bushfire to come again. By Sunday night, though, we have all realized it is good it is only once a year since we will need about 51 weeks to recover. I am not sure we could handle that much excitement in Swaziland all the time!

Wavin' Flag

2010-07-20T15:46:00.000-07:00

I have been feeling guilty for a couple weeks now about not posting. Truthfully, things have been so hectic here that I just have not had time. I have been in Swaziland only one weekend out of the last six and now am getting ready to head to Botswana for a long weekend. I am behind on posts about Bushfire, camping on Sibebe, six world cup games, multiple world cup viewings, fourth of july, a trip to Sodwana, my first Jewish Bris, and soon a trip to Botswana....just a little daunting. I have been realizing recently how quickly my time Swaziland is coming to an end so am trying not to pass up any opportunities to enjoy it. I just downloaded all my World Cup pictures and got really excited to post all those stories. We definitely made the most of having the world cup so close. Here is a quick picture to tide you over until I can post in more detail next week. K'naan's "Wavin' Flag" and Shakira's "Waka Waka" will forever remind me of all the good memories of World Cup 2010!

Spring Break with Giant Sea Creatures

2010-06-14T11:18:00.000-07:00

Some of you may be aware that there is currently some excitement going on in Southern Africa. Don't worry, there will be multiple posts on the World Cup, but first I need to catch up some. I will start with our spring break trip to Tofo, Mozambique.

Prior to our Easter break this year, I had only been to southern Mozambique. I am a huge fan of Ponta and Maputo, but everyone always raves about the beauty and beaches of northern Moz. So Easter Friday, ten of us set off from Mbabane to experience this for ourselves. The reason we had not ventured there before is because of the roads. The relative distance to Tofo is not any farther than some of our other road trips, but you are significantly slowed down by the quality of the roads. This is a section of the road where they are attempting to fix the tarmac. This section had to accommodate two way traffic. It was like a multiple hour game of chicken. Unfortunately for us, the cars coming at us (and some times barrelling quickly up behind us) were large trucks, so they usually won. Luckily, life in Mozambique is vibrant and active so there was plenty happening outside the windows of the car to entertain us for the twelve hour drive. We made a few stops as well. First, for fresh bread. Amazingly yummy. Second, was a stop at a cashew tree. It is a little known fact that cashews grow in plastic bags on trees. The bag we chose was still warm from the roasting. The only food item we did not stop to by that we later regretted was homemade peri-peri sauce. Peri-peri is a Portuguese hot sauce very popular in this area of the world.

I have probably mentioned before that the police in Mozambique are known for being corrupt. They do their best to search for any tiny piece of paper, signature or stamp that is missing on any of 20 different forms that are required for the you and the car. One of the newest rules that they like to get foreigners for, is that every car must have red triangles and a fluorescent yellow vest in case of car trouble. The entrepreneurial Mozambicans have turned this into another opportunity to make money, as you can see with this man prepared to sell a complete car kit. We did eventually make it safely to Tofo thanks to the excellent driving of Michelle and Steph and our beach weekend began. For many of us, one of the main reasons for heading to Tofo was to scuba dive. So early the next morning, a group of us piled into a car to head to Tofo Scuba. Through a series of miscommunications though, we were not all scheduled for morning dives. It turns out that morning dives are all deep and with a normal open water certification you are not able to dive that deep. The did offer Tao and I though a course to get certified in deep dives. So while the remainder of the group went off to dive, Tao and I staked out a picnic table on the beach and whiled the time away, swimming, sunning, eating and sunning. Tao, having forgotten his sunglasses, decided to borrow Tini's since she was in class to get dive certified. The glasses definitely made a statement. For some reason, until Tao's girlfriend, Alison, showed up, there were many young men coming to our table to talk to us...and I don't think they were interested in me.

This picnic table ended up being the groups command central. At any given point in the weekend, one of the ten people in our groups was at this table. People would wonder in after a walk on the beaching, swim in the ocean, or shopping at the market to have a bite to eat or a drink before heading off on the next adventure. The next day, Tao and I did actually get our deep water certification. I was pretty nervous because it was my first negative entry dive. This means that you roll of the boat and go directly down without resurfacing. The dive overall was my most enjoyable dive though. I think I have finally reached a comfort level with diving. The most amazing part of the dive was the giant manta rays. We saw at least three mantas that were around 3-4 meters according to our guides. They are such graceful beautiful creatures.

After the successful completion of our dive, we then headed out on a whale shark safari. Tofo is known for it's whale shark population. Whale sharks are the largest fish species and can reach up to 14 meters. They swim relatively close to the surface so on these safaris, there is a person from the boat crew sitting in a lifeguard like chair at the back of the boat. His job is to look for the shadow of the whale shark. Once spotted, the boat heads in front of the shark so that you roll off the boat to snorkel alongside the whale shark. Our safari was successful. We first saw a young one about five meters than an older one around eight meters. They move slowly filtering plankton from there huge mouths. The size of these creatures was impressive.

At night, the crew would gather back at the house to bathe and cook dinner. Possibly the most impressive part of the weekend was that ten people (including four girls) shared a house with one bathroom without any arguments. Our first night there, Nick skillfully negotiated with a fisherman for some fresh prawns and crayfish. Cooper then worked his magic on the braii. Perhaps it is because I am from the midwest, but I had always though of crayfish as small things you get from a river. Instead, these were ugly large beasts that are surprisingly tasty. Beautiful scenery, lively culture and great food...that is why Mozambique is one of my favorite places in the area.

A Baylor Swaziland Institution

2010-06-02T12:41:00.001-07:00

Monday saw the departure of the McCollum family from Swaziland. Dave and Amy came with the first group of doctors to Swaziland. They came with one daughter, Molly. Four years later, they are leaving with two more children, Lane and Dumisani. They were an anchor in the clinic and are going to be missed greatly. Through all the rough times and negativity, they were always positive, looking towards the future and not dwelling on the past.

Their going made me realize how quickly my departure is coming. It is getting harder by the day to imagine leaving this place. I remember leaving my grandparents house as a child (or was it as a college student) crying when I had to say good-bye. I always thought good-byes would be easier when I got older. They only seem to be getting harder though...or am I just not growing up?

A Day in the Life

2010-06-02T12:27:00.000-07:00

Lucia, standing at the front dest with a boy, pointed at a file and said, "Look at this". The boy had gained 15 pounds in two weeks. I did not recognize the boy so just said, "wow. good for him". Then I saw his mom. I then stammered repeating about three times, "you're from Dvokolwako?" To which, she responded yes...all three times. I kept repeating it because my brain could not fathom that this was actually the same severely malnourished child that had given me the unexpected hug as he left my room two weeks ago. I have seen some amazing transformation since coming here, but none this quick. Even after realizing who he was, he had changed so much I still did not recognize him. I did not even know it was physically possible to gain 15 pounds in two weeks.

A busy day at the adult clinic marked by a trash can overflowing with boxes that patients have taken the bottles of tablets out of then discarded.
A child who entered Pinkett's room and came out with a fabulous makeover including new dress, sweater, tights and shoes. After she left, I entered closed the door and said, "my turn". Pinkett insisted she needed more to work with though.

My drug resistant TB child was discharged from the hospital because he was wreaking havoc, as any healthy four year old that you try to keep in isolation should be!

Dancing through Life

2010-05-27T15:00:00.000-07:00

Matt and I often carpool down to Manzini together. The other morning he got in my car and said, "Whaaat is this?!?!". To which, I replied, "Wicked...the musical". He just looked at me, rolled his eyes a little and said, "you have the most diverse collection of music of anyone I know". I realized then that many of my friends in Swaziland are oblivious to my ability to "sing" multiple musical soundtracks word for word. This talent was inherited from my mom and was cultivated on many a roadtrip throughout my childhood with my earliest memories being of "Pirates of Penzance", "Man of LaMancha" and "Camelot". I was telling Matt that I kind of view them as early "books on tape". They seemed to make the time go faster because it was not only music, but a story as well. I am currently hooked on "Wicked". I realized though when I woke up singing, "Dancing through Life" that perhaps for the sake of those around me, I need to move on. Can anyone suggest a new musical for me?

Mr Grumpy

2010-05-27T12:55:00.000-07:00

Today, I had gone to get a new tray to do a spinal tap. The stock room for these is right by the children's ward. As I was standing there waiting for the tray, I felt a small tug on my skirt. I look down to see one of my patients smiling up at me with a huge grin. It took me a minute to register who this kid with these big eyes looking up at me was. Then the story rushed back to me in a flash.

This four year old boy had been coming to our clinic for close to a year. He always came to clinic wearing a Mr. Grumpy shirt and this is how I always thought of him. I loved it not only because I remembered these books from my childhood, but also because it fit him. He was always kind of a sad, clingy kid never smiling, never playful. We had started him on TB medicines then on the HIV medicines, but he kept worsening. His weight never going above 14.5 kg (30lbs). He was constantly coming to clinic with fevers and pneumonias. It became evident to us that he was failing the TB medications. We added a daily injection, but he still was not responding. We were convinced this was multi-drug resistant TB. The only way to prove that though is to get sputum/mucous from the person. You then try to grow the TB, which takes 4-6 weeks. Currently in Swaziland there is only one place for multidrug resistant TB treatment and they rarely start children without a confirmation. You can imagine with a four year old, it is nearly impossible to get them to cough sputum up into a cup. In children, a commonly used technique is called gastric aspirates. This is when, early in the morning, you stick a tube into their nose down into their stomach and suck out the stomach contents. The thought being that during the night the child will have swallowed a lot of sputum. So I stole pediatric feeding tubes from the Mbabane clinic and asked mom to bring him in early in the morning before eating. The poor kid hated this. He got so worked up during the first attempt that he vomited and all was lost. The second time, I was prepared though. As I was putting the tube down, he started to cough. He sputtered out some sputum and I was able to get it into a jar. Unfortunately, before these results were back, he came back to us in severe distress. We finally got the country TB doctors to agree to start the drugs for multi-drug resistant TB even though we did not have a culture back. The last time I had seen him was about 2 1/2 weeks ago, he was on oxygen, struggling to breath, having some hallucinations and pulling at all the lines. He could not be left alone for a minute, but mom had to get to the TB hospital about 30 minutes away to get the medications. She tried to find someone to come sit with him, but was unsuccessful. I honestly thought it was futile at that point, but made an arrangement with the nurses to watch him for an hour and got a taxi to take mom directly to the tb hospital to get the special medication and back.

So to look down and see this huge smile on relatively fat little cheeks (he is now 16 kgs), I was beyond ecstatic. I swept him up into my arms and started talking away to him in English knowing he was not understanding a single word. The woman finally came with my trays, looked at us, laughed and said, "you found a friend". I beamed for the rest of the day. For the first time since I had met him, he had life in him. He was an active, playful four year old child and...he was finally my friend. I think I am going to have to find him a Mr. Happy shirt now.

Am I there yet?

2010-05-27T10:16:00.000-07:00

Because Swaziland is a predominately christian country we get some random religious holidays off one of which is Ascension Day. This year it fell on a Thursday making it a perfect opportunity for a four day weekend. We don't let opportunities like that pass us by here in Swaziland so a group of us hoped in my little rav 4 and headed off to Lesotho. I had been counting that I had been to Lesotho because I had a stamp in my passport, but really we had just crossed for a few hours. So this trip was to make it legitimate.

Jenny, Charlotte, Tao and I left Mbabane after work on Wednesday to get a jump start on the drive. When I called to book the accommodation in Standerton, South Africa for that night, the gentleman first said there was no room, but then said, "unless all you need is a bed." When I said that is all we needed, he said he had four singles for us for $20. Since we were getting in late, I called about an hour out to tell him we were still on our way. When we arrived, we walk into this nice house, pass a well stocked bar, a pool table, a dining room to our four rooms. We each had our own room with attached bathroom, dstv and he had turned the heater and heated mattress pads on when we called. After showing us the rooms, he showed me where to park the car, told us to bring in our bags and join them at the bar. So we did, we each had either a couple beers or glasses of wine and played a couple games of pool. He then gave us each a glass of amarula while we chatted with some German guys in town to work at the local power plant. Before heading off to bed, the guy told us that he was arranging breakfast for the Germans and we were welcome to join them. The next day when we left, we paid the $20 for the room. He did not charge us for any of the drinks or breakfast. I don't really want to know if this was "just a bed" what other services he normally offers. I will just be grateful for the amazing deal we stumbled into!

The next day, we hit the road fairly early since we knew we had a good drive ahead of us. We stopped about four hours into the drive in Maseru, the capital of Lesotho. We had lunch and walked around a bit before jumping back in the car for our final destination, Semonkong. Semonkong is about 90 kilometers outside of Maseru, which sure did not seem too bad. It took three hours to drive there though because the roads are so bad. Not only are they windy mountainous roads, but they are horrible roads. Our lodger in Semonkong told us that about five years ago they were snowed in for a number of days and Semonkong went dry. The grater truck who was trying to come through to break up the ice went a little too deep. Now the roads are dirt roads with the occasional path of asphalt. On some of the hills, I could not even leave first gear I had to go so slowly. We all agreed it was the worst road any of us had ever driven. I was quite glad when we parked the car and did not move it for two days. I also was more than happy to have Tao drive out when we left.

We finally did arrive at the Semonkong lodge, which sat down in a valley. We were shown to our dormitory, which unfortunately was the furthest from the lodge. It really made you plan trips down to the main lodge carefully. Our dorm was a little stone building with bunk beds and fireplace.

After settling in we head down to the lodge for dinner because we are starving. Unfortunately, we were the last to arrive so we are the last orders to be taken. To pass the time we order a Maluti, the Lesothon beer, from the bar.
The next day, we learned that Maluti in the region has a fairly unique delivery system. This mule was not in any hurry as you can tell, but I am sure it still got there quicker than a truck over those roads would.

We finally get a table, but still there is more time to wait before ordering. I got so hungry at one point, even the candle began to look tasty. While waiting to order, we did have a performance of traditional Lesotho song and dance by some local orphans to pass some time. I really wanted one of these skirts, but did not see them anywhere. Finally it is our turn to order and we cannot believe our eyes. The choices are pork or duck with scrumptious descriptions of how they were prepared. We were not disappointed either. This was some of the best food I have had any where in Africa, which was more than a pleasant surprise in the middle of no where Lesotho.

You may be asking yourself, of all the places in Lesotho, why Semonkong? Well, it was chosen because it has the longest commercial abseil (repelling) in the world. It is in the Guinness Book of World Records at 204 meters. This was the reason we were there. So the next morning, after a breakfast on the porch with a friendly horse, we headed off to practice. We had three practice runs at of 25 meters (just over 8 stories). Going backwards over a cliff is not really my idea of fun, but I was in it for the experience and there was no way I was going to let other people do it without me! I was feeling confident by the end of the practice run, but unfortunately because the rope was wet from the day before our big drop was postponed until the following morning. That afternoon instead, we took a hike through the country side.

Lesotho is a tiny little country that is completely surrounded by South Africa. Sounds similar to Swaziland so I was surprised by how completely different the country is. First, rural Lesotho is much more isolating than rural Swaziland mainly because of the terrain I believe. It also seemed poorer than Swaziland. Another interesting thing, is that there seemed to be more older people. I am not sure if this is true or they just live harder lives so they look older. Because of the distance and mountains between everything, mules and horses are the major form of transport.
Walking through the country side, we encountered by herds of cows and flocks of sheep. Each herd or flock has a young shepherd boy who tends to the animals. You see these young men usually congregating in groups of two to three boys. Each with their balaclava and blanket. Because of the cold, in Lesotho blankets are an article of clothing.
At night, the shepherd boys sleep in these tiny stone dwellings. After walking through the countryside, we toured the booming metropolis of Semonkong. We walked through some of the residential areas where the women were doing laundry in the river. Then we hit downtown Semonkong. This is where you go if you want to catch a glimpse of tv, as these boys were waiting in line to do. Or you come to do your grocery shopping. Minus the satellite dish and truck, this is how I always pictured the wild west. This is also where you purchase your dead birds, which I can only presume are used for muti. Something you can not do downtown though is buy one of these trucks because they are all custom made by their owners.
Kids make these trucks out of wire and other trash in Swaziland as well. The long wire that is lying down at the back of the truck is used by the owner to propel the truck along. I have always been so impressed with the creativity and detail that these boys put into their trucks.

The next morning, we arose to cloud cover. We were nervous that we were not going to get to go on our abseil. It turned out though that the weather was actually perfect that day. The wind from the previous day had died down and it was fairly still. Not only do I think it would have been harder to go over the edge if it was really windy, but you also get more wet because the water from the waterfall blows at you. At the top, I began to have second, third, fourth, and fifth thoughts. Tao wanted to go first. As much abseiling and rock climbing as he has done, this was really nothing for him. I asked to go next. Mainly to get it out of the way. I was only going to get more nervous waiting at the top. So they harnessed me in, hooked me up to the rope and off I went. The worse part was going over the edge. As you back off the edge, you have to pull the rope up and walk backwards. It turns out that 204 meters of rope is quite heavy. It was slow going, but I finally made it over. I love this picture. I have such a cheesy grin on my face. I might have been trying too hard to look like I was having fun!
I told myself that I was not going to look down for a while. Fate was against me though. About four steps over the edge is a 20 meter cave. As soon as you are unable to touch the wall with your feet any more and are just hanging, you automatically swing around. This gave me no choice, but to look out onto the gorge. It was beautiful and I tried to make myself appreciate it. I finally made it past the cave and was able to put my feet on the wall again. This provides a false sense of security, which I welcomed. I slowly continued to let myself down. Occasionally stopping sometimes just to reassure myself I could stop, sometimes to admire the waterfall, and sometimes to look down to see how much further I had to go. If you look closely for a yellow rain jacket and orange helmet you can barely see me climbing down the cliff.
Each time I looked down, the bottom seemed just as far away as it had the last time until finally, I heard someone call out. I look down and there just a few meters from me was one of the crew ready to catch me. Oh, the relief. I had made it! Of course, without being there in person it is hard to comprehend how tall 204 meters (about 68 stories) is. Here are some pictures, to try to help. One of the crew members walking toward the waterfall to collect the next person down. About half of the waterfall is in this picture.

A picture of Charlotte taken from the bottom with Jenny's Canon on full zoom. Finally, the view of the falls as we hiked out.

As we hiked the 204 meters back out of the falls, our guide told us that tourists always take a picture at this rock. We were not really interested in the picture, but in the name of being good tourists obliged and took a picture. We were amused to find when reviewing the pictures that the entire point of taking this, which was to make it look like we were pushing this gigantic rock that was balanced precariously at the top of the gorge over the edge, was lost.

After returning to the lodge, we had our last of three scrumptious meals (chicken schwarma) before Tao drove us out of Semonkong and back to Maseru. We spent our last night experiencing ex-pat life in Lesotho, which unlike the countryside is remarkably similar to that in Swaziland.

While the car was sitting in Semonkong for two days a very sick gaggle of geese shat all over the poor Rav 4. In Africa, all gas stations are full service so your windows get washed, oil gets checked, etc. Just over the South African border we decided to stop for gas mainly so the windows would be cleaned and we would not have to look at bird poop the entire trip home. One attendant started to tackle the front windshield. After a few minutes, a colleague acknowledged the big job his comrade had in store so decided to chip in. He grabbed a squeegee and started at the back window. Fifteen minutes and about four squeegees later, the front windshield, back window, side windows, hood, doors and side mirrors were all bird poop free. I felt sorry for the next car to fill up because instead of getting a cleaner window they were going to get bird poop streaks from the dirty squeegees. Those men ate well that night with the tip they got!

How can two weeks go so fast?

2010-05-23T12:25:00.000-07:00

I am skipping (for now) my easter holiday to Tofo in Mozambique. Unfortunately when my hard drive died I lost some of those pictures so I am waiting to get them back. In the meantime, I am going to continue my trend for the past week of posting like a mad woman to try to get caught up. I will come back to Tofo because the trip was amazing.

In April, I was lucky enough to get to have another visit home. I had initially planned not to come home until I left Swaziland, but when my family left over Christmas I realized that might be too long. There was no theme song to this vacation as the music on the radio was crap, but the visit was still great.

It started in North Carolina. Immediately after landing I headed straight to Sunrise biscuit for my old stand-by a chicken biscuit...every bit as greasy and delicious as I remember. Later that night, the crew got together for Mexican. Saturday after some shopping and sushi with Jen, everyone gathered at Alounthith and Vinay's for a barbecue. As always the spread for the barbecue was ridiculous. My only request was Alounthith's buffalo wings and yet I got so much more! I was lucky enough to pick a weekend where Jen was up from Atlanta, Gretchen and Aubrey came from Pinehurst, and Laura, Sachin and Kathryn were all in town from Baltimore so we were able to get a really good part of our residency crew all together. Working together over 80 hours week with the intense situations you face during residency really builds a unique friendship. Even though I had not seen Julie or Kathryn since finishing it was like it was just yesterday. I remember signing out to Kathryn after a really bad day (an end to a really bad week) in the adult intensive care unit when I just completely broke down. I will never forget the reassurance and support she gave me. I am not sure I would have come back the next day if it were not for her. So for any of you in medicine, still yet to pick a residency program, go with the program where you like the people because they will be your sanity!I also loved getting to catch up with my little Nalin while in NC. He has grown into such a little boy now, running and talking!Why does every boy do this when I try to kiss them though? I thought maybe if I got to them at an earlier age, but no.

Sunday morning, Laura, Sachin and I had a relaxing brunch at Fosters in Durham. We sat out on the porch reading the Sunday New York Times until Laura and I started to get a sunburn. It was here talking with Laura and Sachin that NYC moved to the top of my list followed by Boston. Now if only the job could fall into place. I have never had to go job hunting before. I do not think I am a fan...and I haven't even started yet.

Monday I left NC to head back to Kansas. I got some good bonding time with the folks. Met the newest addition of the Naylor family while getting to enjoy dinner and beer at one of our old med school haunts in Kansas City. Spent an exciting day in Ames, Iowa with my girls. Attended the KU spring football game with my dad, who somehow managed to weasel himself out of all the pictures.

My last weekend in town, my aunt Peg drove down Thursday night and my aunt Nance rode the train in Friday night. Then Shelby and Patrick joined us Saturday afternoon. That night my dad grilled pork and some superb side dishes. The seven us of spent all evening around the dining room table laughing. We then watched a bit of saturday night live before parting ways (some to bed, some to the bar...I will let you guess who went where). I was thinking on the way back to Swaziland how lucky I am not only that I am so close to my extended family but also that they know so many of my good friends.

And Shelby, well, what can I say? There has never been anyone that gives me more shit or makes me laugh harder than Shelby. He is one of those friends that knows all of my flaws, will call me out on them and yet love me for them. You don't find them too often. Amazingly I have somehow managed to surround myself with a number of such people. I owe you all!

Be back soon!

Swazi Hole

2010-05-23T11:25:00.000-07:00

In honor of their moms visit, Doug and Paisley hosted a Braii followed by a traditional Virginian corn hole tournament. The kids bracket started the tournament off. Soloman and Tali were the clear champs among the kids. It became quickly evident in the next match up though that my friends have no qualms about beating kids and before we knew it, tali and soloman's corn holing career was over.

I had never played corn hole before, but I think it must run in my midwest blood. Nick and I formed team Heartland and dominated our first few games easily moving into the finals against the Virginian duo of Steph and Cooper.

Unfortunately, true to my heritage as a Jayhawk I choked when it truly mattered and we lost in the finals. I would like to point out though that Nick and I did have to win one more game to reach the finals than Steph and Cooper. Not being in my top corn holing shape, this might have been the reason behind our demise.

Passover

2010-05-23T10:53:00.000-07:00

One thing I was not expecting when I moved to Swaziland was a large Jewish ex-pat community. Because of this, I have now been a part of many Jewish holiday celebrations. The most recent was Passover at Yael and Shaccar's house. Passover commemorates the emancipation of the Israelites from slavery in Egypt. The last passover I had attended was as a child at our Catholic church. As we went through the ceremony I was surprised by the little things I had kept with me from that celebration. For those of us, non-Hebrew speakers, they had printed out an English version of the Haggadah, the liturgy of passover. We went around the room, each reading a paragraph reserving the Hebrew section for the actual Jewish people at the celebration.

Tali, Yael and Shaccar's middle son, had practiced for days and memorized one of the Hebrew songs. It was a very sweet moment. One of the important parts of passover is the seder plate. The seder plate contains:

1. Lamb shankbone-representing a sacrifice made on the seder at the Temple of Jeruselum.

2. The Egg-a holiday offering brought in the days of the Temple.

3. Bitter Herbs-often horseradish based as a reminder of the slavery the Jewish forefathers experienced in Egypt.

4. A nonbitter Vegetable-Yael used parsley. To symbolized the backbreaking work the Israelites faced in Egypt

5. Charoset-a sweet mixture of nuts, apples, cinnoman representing the mortar the Jewish slaves used for building in Egypt.

6. Lettuce-again to represent the enslavement in Egypt.

A part of passover that I was oblivious to as a child was the role of red wine. Throughout the ceremony, four glasses of red wine are consumed. Lane enjoyed this part of the evening. I am pretty sure she slept well that night!

A day in Cairo

2010-05-23T09:10:00.000-07:00

After leaving Libya, Steph and I met up with our colleagues from Malawi in Cairo, Egypt for a whirlwind 24 hour tour. They had left the day before so were able to give us some useful tips on making the most of our 24 hours. We did an amazing amount in that time and fell in love with Cairo. The most important thing I learned is that Egypt is definitely a country that I want to spend more time in some day. We got in late that night so finally made it to our hotel about 10 pm. The Malawi crew had just finished dinner at a Thai restaurant. In an very generous gesture, they had their leftovers boxed to bring to us. We sat at a hookah bar next door to the hotel enjoying the delicious Thai leftovers. They informed us then that they had arranged for us to have the same guide that had taken them to the pyramids earlier that day. After a quick breakfast the next morning, we were off to the races. We were picked up by our guide and a driver. We got a quick outline of the history of the ancient Egyptian culture on the way to the pyramids. At the pyramids we had a choice, either drive up to the pyramids or ride camels. To me, the decision seemed obvious....camels. Steph being the good sport she is agreed to ride the camels. We bargained for the price of the camels, which unfortunately not a skill I have attained in Africa. We only got a reasonable deal because our driver, who had previously decided that I should marry his son, finally stepped in and said, "No, they will pay this because this is my daugther in law". The first thing I learned was that when a camel stands up, you must lean back or risk falling forward off the camel because he first raises his back legs then his front. The second thing I learned was that camels really are not the most comfortable form of transportation. After approximately five minutes on the camel, I was ready to be the boy leading the camels. In the end it was worth a sore bum, to get to cross the desert on a camel with the workers as opposed to driving up and parking with all the tour buses.

Our first stop was a hill where you could see all nine pyramids on the Giza plateau

The three great pyramids are the pyramid of Cheops, pyramid of Khafre and pyramid of Menkaure (in order of reign). The great pyramid is actually the one in front. The second pyramid appears taller only because it is set at elevation. This is the pyramid of the Khafre who was the son of Cheops. He built it to be shorter our of reverance to his father, but on a higher altitude so that it would appear taller. The smaller pyramids are thought to be for queens and other family members. Below the pyramids are tombs for the workers who built the pyramids.

The final stop of our Giza complex tour was the sphinx. The sphinx is carved out of a single stone. It is a statue of a lions body with a human's face. The model for the face is still unknown. The sphinx is thought to be a guard for the tombs of the pharaohs.

After leaving the Giza complex, we went to the store where egyptian oils and perfumes are made. Biggest lesson learned there...I'm a sucker. I am now the proud owner of Myrrh massage oil, a perfume and rose water face wash. But with that I did get a free glass perfume jar and a glass oil lamp so in the end I think I think I took them for a ride. We did get a demonstration on how the glass products were made, which has always mesmerized me. After that our guide, took us to a whole in the wall restaurant where we filled ourselves with falafel, meatballs and other yumminess for about $1.50 each before heading to the National Museum. Because of our time crunch, we asked for an abbreviated tour hitting the highlights, which in our eyes were King Tut's tomb, mask and treasures and the mummies. This was very hard for our guide, who studied Egyptian history in university and has a true passion for the subject. He kept stopping us in different rooms to show us different pieces explaining how every little detail had a reason. It is such a fascinating and advanced culture. I really would like to study more about the ancient Egyptian culture. Obviously, no pictures in the museum so you will have to go see it yourself.

From the museum we headed to the market to again meet up with the Malawi crew. This is something I wish we had had more time to explore. The market is alley after alley of small stores packed with goods. We had about 1 1/2 hours to walk around while I think you could spend an entire day there.

Our final stop before heading for the airport was a final dinner. We ended up at a Lebanese restaurant and shared about 15 starters between the group. The food was delicious!

From dinner, we headed back to the hotel to grab our bags. We quickly stuffed all our purchases in and the doorman got us a taxi. Teena though wanted to head by the hotel where the Malawi crew was staying, but wasn't sure exactly where it was so at one point she jumped out of the taxi and said, "wait here". Our poor driver, who did not speak English, was very confused. So he called his comrade, our doorman, who had gotten him the job. The doorman spoke to Steph, who explained what was happening, then handed the phone back to the driver. A few minutes later, the phone rang again. The driver answered then immediately handed the phone back to stephanie. I heard her say, "I don't know what terminal. What airport? Let me look". The hotel we had just checked out of had called back to ensure we were going to be taken to the correct airport and terminal. Where in the world, do you get hospitality like that? We had paid the hotel they no longer owed us anything. Steph and I then practiced the four Arabic phrases we had learned from our guide book with our driver to pass another five minutes. It was sitting in this cab, watching all the action of the city at 10 at night that made me decide to come home to a city. Teena finally reappeared and we were off to the airport.

Once at the airport, we went through check in and one security point without trouble. Then as we got to our gate to board, there was a second security point. I could see through the glass that the security guard was throwing away liquids and this is when it hit me that I had packed all my newly purchased oils and perfumes in my carry on. I was hoping to sneak through, but no luck.

I had two choices: throw away the oils or check my bag. Given the amount of money I had spent it really was not a choice. So I checked the bag, but insisted they give me a bag claim tag. When I asked them where to pick it up, they told me to ask in Jo'burg. I did not have a good feeling about this. When I got off the plane in Jo'burg I was told I would have to go to baggage claim to get my bag. This would entail me going out through security, passport control, getting my bag then going back through security in the brief hour we had for our layover. So I was told if I went to the transit desk, someone would escort me through security. Why I believed this I am not sure. After standing in line for a long time, it became evident that noone was going to escort me so I rushed off to baggage claim. I made it through passport control relatively speedily, hurried to my baggage claim and found lots of bags, none of which were mine. So I headed over to the lost baggage counter with my tag. Of course, because it was not a printed tag, the guy did not really know what to do with it. He told me I would have to file a claim and to do this, he wanted me to write my name and contact info on a blank piece of paper. As I was giving up on ever finding my bag, a gentleman came up behind me and said, "oh, I was looking for you. Your bag is over there". And it was. I grabbed the bag, rushed through customs, back through security just in time to board the bus for the plane to Swaziland with all my oils!

My very own Lihiya

2010-05-22T10:39:00.001-07:00

Yesterday at work, after I was done seeing my first patient, the mother pulls a traditional swazi fabric from her purse. I assume that the woman is selling this fabric. It is a given that if a patient asks me to buy something I will. I have been the proud purchaser of aloe toothpaste without flouride, about 20 bags of steak flavored potato chips, 15 bunches of banana, 3 plants, and about 8 rugs. But this time, I actually was interested in what she was selling. Unfortunately, Buhle, who was translating for me, said something to her and she puts it away. So I said to Buhle, "Wait, what is that?". Buhle responded it was nothing, but I was insistent. She finally said, "Dokotela, it's personal. I will tell you later". So I let it drop, they leave the room and I promptly forget about the whole thing.

Later in the afternoon, Buhle tells me that her and Delisile would like to talk to me before I leave. They come into my room, Buhle closes the door and says, "Dokotela, we are going to give our letters of resignation". Our nurse, Pinkett, is always trying to make people believe ridiculous things so my first response to that was, "You are pulling a Pinkett. Aren't you?". But no, Buhle said they just weren't happy. When I asked with what, Deli said "everything". I was stunned and I think close to tears. It was like the wind had been taken out of me. I just said, "what changed?" Then Buhle laughed and said, "No, Dokotela. Deli and I weren't able to get you something on your birthday, but we wanted to do something". And she pulled out my lihiya...the same one I had been wanting to buy from the mother. A Lihiya is the traditional cloth worn by Swazi women. This definitely ranks as one of the best and most meaningful presents I have ever received. Now I just need to learn to tie it before I come home!

Our New Generation

2010-05-22T00:24:00.001-07:00

The first baby I saw that was born to one of the mother's that we are treating to prevent transmission. Mom brought her at two days old sick as stink. I admitted her not sure if she was going to make it. I was crushed that day. These were supposed to be our healthy babies that we just get to play with and hold while seeing mom then tell mom the test is negative. I thought to myself, "I cannot handle it if these kids are going to be dying on me too". Luckily it was just an infection from the delivery and she responded really well to the antibiotics. She is now a month old and growing well. The sweater that she has is one from two huge boxes that Pinkett found in the hospital storeroom. In addition to the sweaters there are knitted bears and dolls. We are not sure what they were for, but we are having a blast giving them out!

It's the Little Things

2010-05-19T13:43:00.000-07:00

Today in clinic, I was seeing a 12 year old boy who weighs just over 50 pounds. I had seen him and his mother two weeks ago. I had treated him for a pneumonia and a fungal infection of his throat in addition to his malnutrition. It was obvious to me without any blood work that he qualified for the antiretrovirals so I talked with mom about bringing a second caregiver for education. He lives a long way from the clinic and mom was not sure she would have money to bring a second caregiver. I explained to mom that her child was very sick and that I would need to be seeing him at least every couple weeks if not every week for likely the next couple of months and that if transport was going to be a trouble maybe she should go to the government health center in the town where they lived. She insisted she wanted to come to us though.

So today, I saw him back. He had lost more weight despite the high calorie peanut based therapeutic food that I sent him home with. Given his severe unresponsive malnutrition I was concerned for TB. I really wanted to get an x-ray and an abdominal ultrasound. I knew when I asked that mom would not have the money (the x-ray is about $1.50 and the ultrasound about $6.50). So I lent her the equivalent of about 8 dollars to get the tests done with the added clause that she would pay me back a little bit at a time every time she comes back to clinic. Now, unless it is a really old gogo without any means, I always add this clause when I give money. I don't count on getting any of the money back, but everyonce in a while am pleasantly surprised when I do actually get something back. In fact, I got $1.50 back from a mother just yesterday.

Anyway, I stood up as they were walking out of my room to get these studies done. After his mother and Deli had left the room, I felt a tap on my right arm. When I turned to look down, with a huge smile and without saying anything, he wrapped his little arms around my waist then walked out of the room. It's amazing that such a simple act that lasted just a few seconds could make all the frustrations of the day/week/month worth it. The challenge though is keeping these moments with you.

The Lion of the Desert

2010-05-19T10:38:00.000-07:00

The last day of the conference was dedicated to sightseeing. I went into this day with very little expectation and, as with the rest of the conference, was blown away. We left early in the morning to drive Jabal al Akhdar, the Green Mountain. The name comes from the cover of pine, juniper, cypress, and wild olive. The drive there gave us a glimpse of the smaller towns and the countryside.

I would have been satisfied with this, but this was only the tip of the iceberg. The first stop was the Qasr Libya. This was the site of a Byzantine fort and church. A museum on site houses some very well preserved mosaics. As we were walking back to the bus, we notice a truck pull up. We were in the middle of the country so it struck us as odd. Suddenly out jumped a detail of men who busied themselves setting up tables for tea and "snack". I put "snack" in quotations because there was actually enough food to be a full meal.
After lunch we boarded the bus again. The next stop was the old Wadi al Kuf Bridge.The man pictured on the sign hanging from the bridge is Omar Mukhtar, the Lion of the Desert. He used desert warfare to lead the resistance movement against the Italians for 20 years. He was captured and hung by the Italians in 1931. Anthony Quinn starred in a movie of the last few years of his life. In the picture below you can see the old bridge at the bottom, the new bridge at the top and in the middle some large caves. These caves throughout the hillside were central to Mukhtar's guerrilla warfare.
So by noon, the tour had far exceeded my expectations, but we were nowhere close to done. The next stop was the Temple of Zeus at Cyrene. We had a very knowledgeable guide who had been working on the excavation of the temple for years. Many statues have been excavated from the site as well including the head of Zeus himself.
Just down from the temple, sat the ruins of the city of Cyrene. The Greeks first landed in the port of Apollonia. They moved inland looking for a water source. At the site of the city they found this spring, which they consecrated to Apollo. The ancient city sat on a plateau with a beautiful view of the Mediterranean Sea.

It was outside Cyrene that I finally was successful in finding English copies of Qaddafi's Green Book, which outlines his political philosophy. I have yet to read this so don't ask too many questions yet.

Since it had been a couple hours, it was now time to eat again. This time we were treated to an amazing lunch inside a cave. After tea and coffee we headed to our final stop, the ruins of the port city of Apollonia (which on a side note was my Grandma Hummert's first name). We were here on the shore of the sea amongst the ruins for sunset.
After an amazing day of sightseeing we arrived back at our hotel exhausted at 10 pm. Again to exemplify Dr. Ali's generosity, he then stayed up until the wee hours of the morning to make us all copies of the "Lion of the Desert" movie. He then awoke early to escort the Romanian team to the airport before coming to rescue the Swazi team at the fish market. He definitely went above and beyond the definition of host. It made the entire experience a unforgettable pleasure.

The Sights of Benghazi

2010-05-19T10:31:00.000-07:00

We did not have a lot of free time in Benghazi, but we did see some sights on the way to and from the conference. The first thing that struck me on the drive from the airport was the traffic. The traffic was not only heavier than in Swaziland, but the majority of the cars only had one passenger, much more American style. The city itself was fairly nondescript. Benghazi is situated between the Mediterranean and a lake so it has a nice waterfront.

But the majority of the rest of the city is very plain concrete high rise apartment buildings with the occasional fancy house thrown in. These were usually separated by dirt lots, but occasionally a little park.
In the lobby of our hotel was a collection of stamps. It is difficult to see in the picture, but we were intrigued by the "American Aggression" stamp. We asked if we could purchase them, but they are no longer on sale. The stamp is a collage of war planes, buildings being bombed with the most prominent picture in the middle a little girl crying holding her teddy bear.

The color in the city was found in two places. First, the shopping district. The area was full of shops similar to this one that sold fancy party dresses including very short dresses. I have never seen a concentration of such formal dresses any where and was quite surprised that this first was occuring in a very Muslim country where the women are all covered. I can only assume these dresses are worn at all female parties or only in the company of your husband.

The second place full of color, and hands down my favorite, was the fish market. We made it to the fish market for a "quick" lunch our last day. The fish market was in walking distance from our hotel. The road was studded with fisherman's boats some with very elaborate designs, some in bad need of a repaint and some in the process of getting a fresh coat. The market was a single alley where the fisherman laid out their catch from the day. There were no other females in sight. As in the picture, most of the men were wearing rubber boats or closed toed shoes. I found out when I walked through with my flip-flops and jeans way this was. Throughout our 24 hour tour of Cairo, when the wind would blow just so I would get a whiff of fish smell and realize it was not the harbor just my jeans!

We handpicked our fish and calamari negotiating for the price. I have no doubt that we got a "special" price.
The fish was then cleaned in front of us.
Once cleaned, the seafood was taken to the grill where it was fried or grilled to your specification.
While waiting for the food, it became evident that fishing was not the passion of most of these men. Instead they were models at heart. All eager to have their pictures taken holding some type of seafood or just big knives. When the food was ready, it came wrapped in a convenient take away bundle. This whole process took a bit longer than we were expecting so by the end we were nervous we were going to miss our bus to the airport. Luckily as we left the fish market, the amazing Dr. Ali was there in his minivan. With a simple, "Come", he waved us over to the van. We hopped in and he whisked us back to the hotel just in time to get our luggage and catch the bus. This meant our feast of seafood was eaten standing up at the back of the bus. As you can see from the remnants we devoured it quickly. Very yummy!

1st Libyan HIV conference

2010-05-17T10:28:00.000-07:00

The 12th annual BIPAI network meeting was held in Benghazi, Libya this March. The only reason the conference actually occured was do to the tremendously hard work of Dr. Ali and his Benghazi team. Dr. Ali worked tiredlessly while we were there to ensure that all felt welcome at all times. I have never met a better host. I can only imagine how much time he put in before we arrived. More than once before the meeting we got an e-mail cancelling the conference. Usually the same day, we would then receive an e-mail saying the conference was back on. I now believe that was because Dr. Ali was working his magic. The first cancellation was when we were told our visas would be waiting for us when we got to Libya. Houston felt it was just too risky to buy plane tickets for everyone without a guarantee that we would be able to get into the country. This was sorted and it was agreed that the visas would go to our airlines. The next cancellation was when we were told just a week before the conference that our passports had to be translated into Arabic. Again, that same day an e-mail was sent out saying this was not the case and the conference was back on. Given the back and forth we were not sure when we boarded the plane in Matsapha whether we would actually make it to Benghazi. We did with only one slight obstacle thrown in our path. In Cairo, Egypt Air was refusing to let us on the plane without, you guessed it, Arabic translation of our passport. Luckily one of the doctors had a contract phone and was able to get ahold of Dr. Ali. Dr. Ali made some calls and a little while later we were on the plane. I should mention that this phone call was at 5 am the same morning that Dr. Ali met the Houston team at the airport in Tripoli at 2 am. We finally arrived in the country and were ushered through immigration and customs. We handed our passports over to this gentleman. It was a couple of days before we saw our passports again, which was a little concerning, but worked out fine in the end.

It was not only Dr. Ali who made this conference happen. There was a whole team. Everyone was quite excited to be hosting the 1st Libyan HIV conference. I know am the proud owner of a leather briefcase, pen, paper, pin, and key chain all with the logo on it. To the left of the sign you can see one of my favorite pictures of Qaddafi. For some reason, it reminds me of the Dude in the Big Lebowski. The conference was a four day event held at the hospital. This is a national referral hospital as well as teaching hospital. The resources at the hospital were much more similar to the hospitals we were trained in at home than to our current working environment.

On that first day, the red carpet was literally rolled out for us.
We were then saluted by the military band. Who knew that bagpipes were part of traditional Libyan music? I sure did not. The first night we got all gussied up in our best and headed to a formal dinner. Not to brag, but the Swazi crew was definitely the best looking of the bunch. We walked into an elegant ballroom to the accompaniement of local traditional music. This was what the traditional bag pipes looked lie.
The food throughout the conference was amazing. The main meals were all had a mediterranean flare to them. At each break we were also fed amazing delicious pastries and biscuits.

The first day, we made friends with a local woman named Fatima. She was a single woman in her late twenties who worked in health education. Over the next few days, she graciously answered all our questions about life in Libya for a woman. The last day she brought one of her rings as a gift. She also brought pictures of herself with her head uncovered in a short cocktail dress. The pictures were taken at her sisters wedding. She explained that the weddings normally last a few days, but the bride and groom remain separated. It was only because there were no men present that the women could be uncovered. This dinner also provided us an insight into the relations between sexes. To the left of the stage, were tables filled solely with men. To the right of the stage were the mixed tables of the other countries and tables of mainly women. There was an occasional male partner thrown into the mix.
Despite this obvious separation, it was obvious through our few days there that women make up a fair percentage of the work place. In the conference, they were treated as equals.

The second day, I gave my talk on our experience with multidrug resistant TB in Swaziland. Swaziland has the highest incident rate of TB in the world. Do to many limiting factors, we are beginning to face more of a problem with this TB being resistant.

The lectures continued for one more day then we got the fun day of sight seeing so stay tuned for the next post.

Who would have ever thought...

2010-04-13T14:51:00.000-07:00

That I would be able to pick out measles from across the room. This has occurred because Swaziland has been having a major outbreak for four months now. Never before had I ever seen measles. I can now walk into the waiting room and from across the room say, "he has measles. let's get him away from everyone else". I can recite the natural course to parents in my sleep. Runny nose and cough, followed by the high fever and red eyes. Around the time of the fever, you can see Koplik spots in the mouth. These are pathognomonic for measles but sometimes are not present. It is pretty subtle in this picture, but if you look just above the lower molars you will see tiny white dots...those are Koplik spots!

Following the fever, the a red fine rash starts at the hair line on the head and over a number of days works its way to the feet. About a day after the rash reaches the feet the fever should subside. If not, then you were lucky enough to get a complication of the measles and that's a whole other blog.

Things that are not emphasized in the books are just how miserable people with the measles are. Besides the actual flu, I have never seen anyone feel so bad from a respiratory virus. I had a 13 year old boy, who is one of the toughest kids I know, in tears in my room because he felt so bad. It is not a quick 3-4 day illness either, these people are sick for close to two weeks.

So, moral of the story, those of you who are parents, please vaccinate your children!

At least it is more interactive than a magic eight ball

2010-04-12T13:56:00.000-07:00

Although probalby not much more accurate. Forgot to mention that I had my bones thrown while in Zimbabwe. This is the first time I have ever gone to a fortune teller. Here is what I found out:

Overall, I am a happy person, who gets on well with people and is "strong as a man".
Love: going through a difficult time right now (thank god, because if swaziland was the highlight of my love life that would be depressing), but I have a long marraige life ahead.
Children: after some hard times my first child will be a boy
Success: He said I would be very successful and that I still have many things to do. For Charlotte he mentioned that she would come into job with a lot of money in the next few years. He didn't mention money any time in my future. Not too surprising, but still a little disappointing.
In the end, I will have nine grandchildren. And somewhere in there at the end he threw in "strong as a man" again.

Will let you know in a couple decades just how accurate bone throwing is!

New Roomie

2010-04-12T09:44:00.000-07:00

This guy was hanging out in my bathroom yesterday trying to sneak a peak.
As far as bugs go, he is pretty cool. It is hard to see in the picture, but he actually had veins and little detials that truly made him look like a leaf. I wasn't fooled though. Those long legs and antennas made me pretty sure I didn't want him on the loose close to my bed. So with the help of my neighbor Elaine we freed him today. The last I saw him though he was crawling back toward our sliding glass door. I will probably wake up to him on my bathroom door again tomorrow.

Anybody want a peanut?

2010-04-11T11:43:00.000-07:00

The last part of our trip, Charlotte and I spent in the Okavango Delta of Botswana. We got a bus from Victoria Falls, Zimbabwe across the border to Kasane, Botswana where we caught a chartered flight. This is by far the smallest plane I have ever riden in. It was the pilot, Charlotte, myself and our bags. The ride was great, but I was not able to fully relax because I was sitting right next to the emergency door and was afraid I might lean on the handle in the wrong way.

The runway was in the middle of nowhere and a popular hang out for warthogs. Our safari guide met us at the runway and we left straight away for our first game drive. We saw some elephants, giraffes, zebras before stopping for our sundowners.
During our sundowners, our driver was explaining to us how they use the calls and activities of animals to find potential predators. He stopped in the middle of a sentance and said, "that is a monkey warning call" then continued. By the time we were down the monkey was still making his warning call I asked if we could go in that direction. As we approached, the driver spotted the monkey up in a solitary tree looking down. Because this was a private park, we did not have the restriction of staying on the road. Our driver headed directly through small trees and bushes to get to the bottom of the tree where he spotted a leopard. We were amazingly close to the leopard. You can see in the picture below how close she was to my arm rest. Our driver was talking in his normal voice, but kept telling us not to move. At one point the leopard stood up staring at us. Charlotte and I were both a tadbit nervous knowing how fast they are. She eventually laid back down though. We hung out with her there for close to half and hour. We finally headed to our lodge to get settled in. The lodge consisted of 8 luxury safari tents and a main common area and dining room. The camp is not fenced so each tent has signals in case of emergency. During the day, if there was an emergency we were to use the air horn four times to signal there was trouble in tent four. If it was in the middle of the night, we were to radio. All the managerial staff carried the radios 24 hours a day. We didn't get to test these out although one more when we were walking to breakfast we saw leopard tracks.

It is low season in the Delta right now so the lodge was relatively empty. The first night there was a Dutch family with us, but they left the next day. For the remainder of the time, Charlotte and I were the only guests. Each day there was a huge layout of amazing food just for us. The staff is flown into the camp for extended periods of time so are not able to leave on light days. Because of this the staff to patron ratio was quite high. Uncomfortably so at times, especially when you had three women standing around just watching you eat waiting to get anything you might want.

The Okavango Delta is the world's largest inland delta. The Okavango river drains the summer rains from Angola then spreading over a 250X150 km area of the delta. The floods actually hit the delta during its "dry" season (any time from May-June). The terrain is a combination of canals, lakes, swamps and islands. We were there during the rainy season/summer so the swamps were full, but it was hard to tell because the grasses were so tall. From the car, it just looked like prairie fields of tall grasses. Until you started to drive from one island to the next, then you realized those grassy lands were actually full of water.

The natives used wooden dugout canoes, called Mokurus, to traverse the area. We took a Mokuru tour one morning. We affectionately referred to our Mokuru guide as Andre the giant. He was a huge man with an amazing sense of balance who spoke in a very deep monotone voice. I kept expecting him to start rhyming. We stopped at one point and quietly our guide pointed out to us that their was a hippo straight ahead. You can see his head just through the grasses. After a few minutes he started to splash around. I have never been so intimidated. You feel pretty defenseless in a little wooden boat.

Our only other big find was a hurt hyena that Charlotte and I both fell in love with. You can see the big gash on his right front leg.

He looked so sweet and cuddly. On the way back to the lodge our last day, our car got stuck in one of the swamps. Charlotte was able to get this amazing picture of one of the water lilies. The cars engine was still on which is why the water was all choppy. I had to pee pretty bad. I thought for a second about leaning out the car door and peeing into the water, but instead just sat uncomfortably in the car. Another car from camp came and pulled us out and I made it to the restroom. Charlotte's week long illness culminated in a pretty empressive pink eye. Our guide was very concerned about the eye and really tried to push us to let him give us drops for it. We tried to explain that drops would not help, but I am pretty sure he was not convinced. The eye and Charlotte did recover completely from the illness and I amazingly, despite sharing beds, never got a pink eye!

Terminator 2

2010-04-11T00:49:00.000-07:00

Initially when I moved to Africa, Vic Falls was on my list of places to see before I left. As I stayed here longer though, Vic Falls moved from close to the top of the "Must See" list to the "Is is really worth it" list. First because it is one of the most touristy places in Africa.

Second, how long can you spend at a water fall? Is it really that impressive? I have seen Niagra Falls do I really need to see Vic Falls? I went through all these thoughts when Charlotte and I were deciding where to go. Eventually, we agreed we should probably suck it up, pay the cost and go to see Victoria Falls. We added on the Okavango Delta in Botswana to sweeten the decision a little.

In the end, Victoria Falls was amazing. I am definitely glad I did not concede to my misgivings. Our first day, Charlotte and I started at the zimbabwean national park. The falls is such an interesting geologic phenomenon. The Zambezi plummets into a narrow transverse chasm where there was a fault line. The water then all is directed out a narrow outlet to the gorge. Because this chasm is so narrow the path you are walking on is amazingly close to the falls. So close in fact that the mist from the falls had us soaking wet and convinced it was actually raining. We were there during the rainy season so the water was quite full.

I tested the limits of my camera on this walk and unfortunately found the limits. It is called the danger point. After this picture at the danger point, my camera will still take pictures, but the screen does not work any more. Oops. The falls are impressive from the ground, but it is hard to get the full expanse of the falls. It was not until I did the helicopter tour that I got the full impact of the 5600 feet wide falls. Even from the air it was hard to get a picture that captured the entire length of the falls. The picture demonstrates how the water does not fall from a mountain or high land, which is how I tend to think of waterfalls. Rather it falls into a very narrow chasm in a otherwise flat plateau.

After walking along the falls, Charlotte and I moved onto the beginning of our adventure activities. Neither of us were brave enough to do the bungee jumping or the gorge swing, but we did do the flying fox, zip line and abseiling. All enough of an adrenaline rush for me.

We started with the flying fox. This is basically a zip line with the harness on backwards so you are facing down over the gorge about 80 meters below you. Obviously the hardest part was building up the courage to run off the platform. The flying fox offered an amazing view of the gorge, but was somewhat slow and our least favorite of all of the activities. Next on the list was abseiling or repelling down into the gorge. I have always been interested in trying this. Now I it is not easy to make yourself walk off a cliff mentally or physically. Before starting they made us lean back and let go to demonstrate how secure the harness was. I just tried not to look down. My arms were really tired by the time I made it down. Charlotte was much better than I was. Our final adventure was the zip line, which was by far our favorite. It was longer than the flying fox, it was faster and it dove down into the gorge. You can try to follow the small dot in the pictures below to get an idea of just how long it is. After our adventures, we headed back to the lodge, showered, and had a sundowner on the deck before heading to dinner. We ate dinner at The Boma restaurant on the premises of our lodge. This was an interactive "African" experience. This was the first time I was pulled up to the dance. I think I must give off some, "I am willing to make a fool of myself vibe". I cannot wait to carry on the Hummert female tradition of embarrasing your children by being willing to do anything I was the only one to be pulled up to dance with these dancers then later in the drum circle was picked to be the one to start the dancing.
The next day, we went whitewater rafting on the Zambezi.

Because the water is so high we were only able to do the second half, but it was well worth it. I got thrown out of the boat for the first time ever while rafting during the Terminator 2. Myself and the guy sitting next to me went in. I like to think that I was sacrificing myself because the guide said if we had not gone in then the whole boat would have flipped. I came up right by the boat and before I could even figure that out the guide yelled grab the rope. I looked up, grabbed the rope and before I knew it was back in the boat. I wish I could get the clip of me flying out of the boat onto the blog, but I am not that talented.

That evening we went on the sunset cruise, aka the booze cruise. Again, pulled off the boat to dance. I must look all to eager to join in.

On the cruise, we came the closest to hippos that I have ever been. Even though we were on a large boat, the captain said if we got too close the hippos could destroy the hull.
On the cruise, were two young children, a little boy about 4 and girl about 6, who were sitting on the top deck with their parents. Shortly after taking off though the children came down to wreak havoc on the lower deck. I think the captain was about to blow a gasket. The boy kept asking how fast he could drive the boat then would precede to tell the captain he could drive it faster. They were climbing all over everything. The little girl at one point was on top of the bathroom. The captain had to stop the boat once to pull the boy off the front of the boat because he was afraid he was going to fall in. We were sitting right by the captain and had been having a discussion about where the children were from. I was of the opinion that the children were from the developed world, but had to have been living in Africa for a significant period of time. In an attempt to save the sanity of the captain, I made friends with the kids. I was correct in my assessment. The children were Swiss, but lived in Johannesburg. They were both incredibly sweet, but definitely mischievious. At one point the little boy had climbed up on to my lap with the girl standing next to me. When I asked Charlotte to take a picture of us, the little boy scampered off. Here is the little girl. She reminded me of Pippy Longstocking for some reason. After the booze cruise, we headed over to the Victoria Falls Hotel. This a huge old colonial hotel that sits in the national park itself. That night there was a full moon so the view was amazing. You can see the mist from the falls. Because the landscape is so flat this is visible from a great distance away from the falls. Our initial plan had been to have dinner there, but then we decided it was too formal so we decided just to have an "I presume" drink on the porch then head back to our humble lodge for dinner.
The next morning before heading to Botswana we decided to visit the market. I have never encountered people so willing to trade. They wanted anything and everything from t-shirts and shoes to my hair rubber band and candy. Charlotte was buying a metal turtle and topped off the money with a handfull of melted together hard candies, a bag of peanuts and a cookie. If only I would have known I could have outfitted the Zimbabwean nation in Kansas Jayhawks t-shirts and gotten a whole suitcase full of crafts.

Soweto on Bicycle

2010-04-06T11:08:00.000-07:00

At the end of February, my friend, Charlotte, came for a visit. Somehow I mixed up the day she was actually arriving in Johannesburg, which resulted in us having a full day in the city. I booked us into our usual backpackers in Melville. When we pulled up, Charlotte, who had lived in Jo'burg for a month during medical school, said, "this place looks really familiar, but it can't be where I stayed. They must all just have similar look". The owner, as we were getting out of the car, looked at me and said, "you have stayed here before, right?" then looked at Charlotte and said, "so have you". As we walked around back to our room, Charlotte realized this was indeed the place she had lived for a month. What are the chances?

The next day I had arranged an all day bicycle tour of Soweto. Unfortunately we awoke to pouring rain. We drove all the way to Soweto, but then once there decided with the tour operators that we did not want to be on bikes in Soweto during that weather. So we took off for the apartheid museum hoping that the weather would clear enough for us to do an afternoon bike tour. The apartheid museum was really interesting, but dense. I think my brain was full after only a few of the exhibitions. I think I would gain more from it tackling it bit by bit over a few days.

After that we headed back down to Soweto. The weather was still questionable so the guide convinced us to do a car tour. We learned that Soweto, which is an abbreviation for SouthWest Township, is actually comprised of many different townships or suburbs (eg Orlando, Orlando West, Dube), each with it's own character. We started our tour in one of the poorer areas of Soweto at one of the local drinking establishments. These establishments serve traditional beer that used to made in calabashes by the women on the homestead. Today, it is mass produced and sold to the consumers in paper cartons labeled, "Joburg Beer". This neighborhood was initially built as housing for mine workers. Four mine workers would share one tiny room without electricity or running water. Some of the newer houses now have running water and electricity .

Many still do not have running water or bathrooms. Here is a picture of one of the public places for water. The signs are reminding people to take care of it because if it breaks down it might be months before it is fixed again. It also informs people that anyone seen peeing or defacating in the area will be fined. After this we headed to the memorial park for Hector Pieterson was a school boy during the 1976 school demonstrations. The students of Soweto planned a peaceful march against the ruling that Afrikans should be the language used in school. As the children marched towards Orlando West, the were met with riot police. What was supposed to be a peaceful march ended up in violence with many students dying. Hector Pieterson was the first victim. This picture of a young man running with Hector's body toward the clinic while his sister runs alongside screaming quickly became the international picture of the Soweto riots. Unfortunately at this point in our tour Charlotte started to feel ill. We thought that perhaps it was jet lag and a little dehydration so we decided with our guide to get lunch. Little did we know this would be the beginning of a week long illness for her.

Our guide took us a nearby local restaurant for lunch and this is what came...
What is that you might ask? Well it is a quarter of a loaf of white bread with mayonaise, ketchup, french fries, hot pink processed meat, egg and processed cheese. Yeah, tasted about the same. Surprisingly this did not make Charlotte feel better so we cut the tour short swinging by Nelson Mandela's and Desmond Tutu's old houses before heading back to our lodge for a good nights rest. The next day we were off to start our adventures in Vic Falls.

Siyancoba!

2010-03-31T09:41:00.000-07:00

I apologize for my blogging abscence. I have been very busy...have added four new African countries to my passport, have officially been to all of the southern African countries, have visited one of the natural wonders of the world (victoria falls) and visited the only existing ancient wonder of the world (pyramids of giza). Obviously I have a lot of catch up to do on the blog, but wanted to start with a post that I initially started writing in December.

Siyancoba! We are the champions!

The Manzini teen support group had our first official meeting in November 2009. During this meeting after a lot of brainstorming and an offical vote, the children decided they wanted their group to be known as "The Champions" because they are beating of HIV.

Our teen support group meets the second saturday of every month. Children from our clinic who are between 10-18 who know they are HIV positive come to clinic for different activities. We provide money for transport and just recently a local catering company started to donate lunch for the children and volunteers. The support group is to meant to provide a safe place where the kids can come be kids as well as interact with peers facing similar issues. We do our best to balance having fun with learning. Our ultimate goal is for these kids to transition as smoothly as possible into adulthood. Honestly though I think the volunteers get as much from the group as the kids. Last month I was not feeling well so came late. The only reason I went was because I had promised a couple of kids that I would be there. As I walked in I got hugs, after a while of hanging out with the kids I was feeling better...there is no better medicine.

Over the last few months some of the issues we have dealt with are:

What does HIV do in the body? We demonstrated this with a game that the children really enjoyed. I think it helped them understand better some of the strange words (CD4, immune system) that they hear in clinic and school.

We have also discussed feelings. Through activities we tried to get the children to recognize different feelings and come up with ways to cope with these feelings.
After that we discussed supporters in their lives. We tried to get them to identify people they could rely on and go to for help as well as how they could be supporters to people in their lives. Our last meeting we talked about how to make good decisions in life.

It's not all serious though. We to keep the kids engaged by adding in purely fun activities. The most requested activity is always dancing. It is an interesting mix between hip-hop dance and traditional swazi dance. It is one of the few places I get to show off my Swazi dance moves, which I have been working on for the last year and a half.

When not dancing, we pass the time with a variety of other games. I have never had such a large repertoire of children's games up my sleeve. At the end of our November support group we had an unofficial opening of our clinic. I was initially scheduled to be out of the country for the opening of the new building so Pinkett, one of the best nurses I have ever worked with, kept joking that to her the clinic would not be open until I cut the ribbon. This is very flattering given the fact that she has really been the one that built the clinic and so should be the one cutting the ribbon. Of course, as things always are in Swaizland the actual opening was postponed. The minister of health kept delaying so finally the government sent someone to tour the building and give us permission to start operations while we were awaiting the official opening. Of course, that day we had so many patients that I stayed behind to see patients so the rest of the team could go for the "blessing" of the clinic. So at the end of the support group Pinkett surprised me by bring out a ribbon and scissors. She insisted on having me cut the ribbon. I agreed under the condition that we would cut it together "unofficially" opening the clinic. Four months later we are still waiting for the minister of health to have our official opening. Each kid took home a small piece of the ribbon.

In addition to our monthly support groups, an American NGO called "Hole in the Wall" helps us run a yearly teen camp. This year we hosted two four day camps in December. The first for 10-13 year olds and the second for 14-16 year olds. For the second year in the row I have been lucky enough to get to be one of the camp doctors. As camp doctor you dispense their daily drugs as well as address any acute illnesses that come up. This is one of the most enjoyable while at the same time tiring assignments since I have been in Swaziland. Most of you know how deep of a sleeper I normally am (if not, to give an example, I slept through a fire alarm in Libya), but this week I slept as lightly as I did on call. My room was right by the bathroom so everytime someone came to the bathroom I awoke convinced they were coming to get me. In the end there were no night time consults while I was there, only a lot of full bladders. This year at the end of the week, the kids put together a stage night. We were able to scare up a pretty good audience for them.
The children were divided into four groups and each was to prepare their own act. The stories that were performed were a sad reflection of the life these kids lead. One of the dramas the girls acted out was a girl being sexually abused by a neighbor. The other was regarding a drunk mom coming home and smothering her child when she passed out. The fact that these were topics that were conceived by 10-13 year olds makes you realize they have been exposed to many things that no child should have to deal with. In contrast to their plays each group also put together an act about dancing (you should be noticing a theme). I have to say that my RFM kids have definitely benefited from studying under my tutelage. Below are two of my girls leading their group in a dance. One of my boys demonstrating my specialty Swazi dance. And finally, one of my kids acting as a body guard for his rapper counterparts. Where they have learned to emulate gangsta rappers I do not know, but they have the act down pat. I think the kids really enjoyed putting a show on for the crowd. In between the two teen camps, Sarah, the American deputy ambassador, hosted a christmas party for the teens. She learned about our group last year during a tour of the clinic and has been one of our biggest supporters since then. This year she offered to open her house to the 150 children for the annual christmas party. On top of this she secured donations from the US, provided food and drinks and volunteers to help keep the kids under control. I also provided two volunteers, my parents. Sarah lives within a couple blocks of the clinic so the head of security for the Embassy walked all the kids from the clinic down the road to the house. Luckily it was beautiful weather so we were able to have it outdoors. As always there was lots of dancing and other games. Each child received a full meal. In order to ensure there were not double portions given, each child received a necklace after getting their food. The icing on the cake was that Sarah had arranged enough donations that as the children were leaving they each received a stocking stuffed full of goodies including a stuffed bear.

Thanks to Sarah, all of our children received at least one gift during the holiday season.

New Years on Swazi Time

2010-02-23T14:08:00.001-08:00

We had been talking about our new years eve plans for weeks. Noone was really excited about any of the ideas being tossed around. It came down to the very afternoon of New Years Eve for people to come to a concensus to go to House on Fire. House on Fire is normally one of our favorite venues, but we just were not too excited about theme of the evening (A tribute to Michael Jackson). Don't get me wrong, I like MJ as much as the next. Thriller was my first cassette tape, but even in Africa we have been dealing with the endless series of tributes to the man. I should not have doubted the King of Pop though. Of course, he would deliver an amazing New Years. Full of good friends and dancing.

As time approached midnight, the countdown began. It was not a traditional countdown. It did not seem to be related in anyway to actual time. It started at 43 then 30 seconds later 30 then a minute later went back to 35 then out of the blue someone yells, "Happy New Year". Looking down at my watch, I realized it was actually 12:03. In true Swazi fashion, we celebrated New Years late. Then because the countdown was so poor that some people missed it there was a request to do it again. So the dj threw on "one more time" and a real countdown began (10,9,8,7,6,5). I think the second new years was actually better than the first. The party was in no danger of slowing down though. The dancing continued until around 4. I was climbing into bed as the sun rose on the new year.

The next day everyone was up for a relaxing day. The weather was gorgeous so we headed down to our friend Nick's place for a braii and swim in the river. Nick is lucky enough to have the river as his backyard. Now amazingly enough in Swaziland there are sometimes holidays called at the last minute (like a Monday holiday being announced on Sunday). These are often the traditional ceremonies like the Umhlanga (Reed Dance) or the Incwala. The reasoning is that they are based on the moon so that they just have to wait and see when the full moon occurs. Silly me thought that the phases of the moon were something scientists new for years in advance, but I guess not. Either way, there was rumor that the Monday after New Years was going to be a holiday making it a four day weekend! We were confident enough of this that we decided to plan a weekend away. Turns out that a lot of people also like to travel on New Years weekend. Who knew? It came down to one option: Mbuluzi game reserve with a trip to Maputo Mozambique for seafood on Sunday.

Even though this was our only option, I was quite excited. Dan and Meredith had been raving about this reserve for over a year and I had yet to be there. In fact, they had planned a going away weekend there but it had rained so much that the bridge was washed out. As soon as we arrived, I could see why they had fallen in love with this reserve. Each camp consists of many different living quarters with a main entertaining house. We stayed in two different camps both very nice. One of the great things about Swaziland, is that while it can get hot during the day, it usually cools off at night. This makes for almost perfect fire weather year round. Lucky for us, our friend Joe who was back visiting had brought his fire master friend, Chris. He was able to get a roaring fire going despite all the wood being wet. The next day we headed to Maputo for a good seafood lunch. We had decided to take Joe and Chris's rental car across the border because Tini's registration is not fully up to date. Unfortunately, for a rental car you have to tell them that you are planning on going to Mozambique. Turns out the people on the Swazi side take this policy very seriously. When the handwritten piece of paper did not say "Mozambique" on it, the border patrol was not going to let us through. He told us that he was going to call the rental company on his cell phone to check. He disappeared off into the building for a good ten minutes. He returned saying the rental company was going to call him back. Now this is fairly unbelieve knowing how precious airtime is in Swaziland. It was hard for all of us to believe this guy took his job so seriously that he would call a car rental place with his own minutes. When he came back, we tried to negotiate with him explaining that we were only going for the day. He was not hearing it though. Joe finally said, "they live here. they are doctors here". To which the guard replied, "can i get a job?". After a few minutes of Joe trying to figure out what a police officer would contribute to our clinic, he then tried to bargain Chris for entrance to Mozambique. We would leave Chris, head to Mozambique then come back in the evening to collect him. The patrolman finally cracked a smile and opened the gate for us to go through.

As we were waiting the 30 minutes to sort this out, we realized that we should have just written Mozamique on the rental agreement before getting to the border post. So between the swaziland side and Mozambiquen side, Chris suddenly lost all ability to drive a manual. He killed the car many times...giving Steph just enough time to add Mozambique to the rental slip. We had no problems getting through the Mozambiquen side!

When we arrived in Maputo we headed straight for the fish market. The fish market has many restaurants set up around it. Once you find a table, your waitress then helps you pick out whatever fresh seafood is appetizing to you. She then takes the seafood back to the kitchen where it is prepared and brought to your table. It is always very yummy.
After a short walk on the beach we headed back to Mbuluzi for the night. The second night we stayed at the tented camp that our friends, Steph and Matt, had built. It is really unique and very thoughtfully designed lodge. Again there was a main lodge then three safari tents with private bathes and outdoor showers. I am always won over by an outdoor shower. The camp also had a nice pool where we enjoyed an evening dip before warming ourselves beside the fire. Couldn't ask for a better, more relaxing New Years weekend. Although you could ask to follow that weekend with a weekend in Ponta D'ouro, a southern Mozambique beach town. Everyone raves about Northern Mozambique and I will find out why over Easter, but I will always have a special fondness in my heart for Ponta.

The way we have always driven to ponta is through the swaziland-mozambique border. After crossing the border, there is nothing but beautiful empty countryside. Until, this little green and white mosque, aptly names Mesquita, appears out of nowhere like a mirage. Just past the Mesquita comes the turn off for Ponta. After the turn the roads quickly deteriorates to a rough dirt road then about 20 km outside of Ponta to sand. I say "road" but by the time you hit the sand it is really just multiple sets of tracks going off in what seems like a millions directions. The key is to stay calm and realize while you have no idea where you are, all the tracks lead to the same place in the end.

The next two days were heaven. They were full of all of my favorite things. There was plenty of ocean, beach, seafood and caipirinhas. The hotel we stayed at was right on the beach. Sometimes we did not even make it down to the beach, just opened the living room door, sat on the couch and enjoyed the view and sounds of the ocean. But reality set in and before we knew it, we had to head back. For the first time ever, we went through the mozambique-south africa border then around to swaziland. This overall is a nicer road, but there were a few flaws in the road. This sign mentions "potholes", but I did not actually see any of those. I only saw craters swallowing cars in front of us whole.

Always sad returning from a nice beach weekend, but luckily there are a couple more on the horizon.

If you can't tell the pictures in this post are a little higher quality than the normal ones. Thanks to Joe for all the great pictures!

The boy is a trailblazer

2010-02-22T13:27:00.000-08:00

Hiking with Tao: always fun, ALWAYS an adventure!

A numbers game

2010-02-18T10:34:00.000-08:00

So part of my role as supervising doctor at our RFM clinic has been to attend more meetings than I really care to. I am not a fan of meetings in general, but then when you add on that everyone is 30 minutes late (at least) and the meetings are horribly inefficient I get really restless. I have learned a few interesting tidbits though.

Yesterday, I learned that last year there were around 8500 births at RFM hospital. That is on average about 23 deliveries a day. With an HIV rate of 42% in the prenatal clinic this means about 3570 kids exposed to HIV every year. Based on the best data we have currently our estimated maternal to child transmission rate is between 8-12%. So every year at RFM alone, there will be between 285 and 428 babies infected with HIV a year. That is one hospital in one tiny country in Africa. To put that in perspective the CDC estimated in the entire United States in 2007 that there were 139 perinatal cases of HIV.

Obviously with our hospital mortality, we struggle once the children are infected so this only reinforces that to really help the Swazi children we need to focus on the mothers before the child is even born. At RFM we have recently transferred the care of the pregnant women from the adult HIV clinic to our clinic. We are doing our best to fast track these mothers to get them on HAART as soon as possible as well as counsel them on infant feeding and family planning after they deliver. Hopefully, with proper prevention of maternal to child transmission and counselling of our mothers, we can start to reduce our rate of newly infected babies!

Let's do the time warp again!

2010-02-16T11:42:00.000-08:00

The time was December 2009, the place Sodwana Bay, the mission scuba diving.

The trip started with beautiful sunny weather until we got to the Swaziland-South Africa border. There we hit an intense storm. The wind was so strong it was blowing over signs and bending the tin on the roof. The lightening and thunder felt like it was just over us. Doug, Phil and I were still in the border house and I think were the luckiest. Steph, Fiona and Michelle had gone to the woman's restroom. Believe me this is not a place you would choose to spend 2o minutes, but the girls did because the storm was so intense they did not feel like they could leave. Jason, Paisley and baby alex were in the car. The car had been pulled under a large domed tin roof so Jason said it felt like they were in a really powerful car wash. Luckily the torrential rains and heavy winds passed after about 20 minutes and we were able to reunite and continue on our journey. The remainder of the drive though was lit by some spectacular lightening that was snaking across the sky. We arrived just in time to get dinner at the restaurant. I had the yummiest prawn curry I have ever had.

The next morning we awoke early to head down to the beach for scuba diving. Remember that I am still a relative amateur so still get somewhat nervous with the equipment preparation, etc. This was not helped by the fact that the last time we went scuba diving in Ponta d'Ouro I felt horribly nauseous. I did not actually get sick, but did not feel well. Well, I made up for that this time. The ocean was still rough from the storm the night before. I somehow managed to puke before we even got into the water to dive. I was ok once we got underwater, but the surge even underwater was quite impressive. It was interesting to watch all the fish swimming one way then just be carried to the left for a few minutes then back to the right. I wonder if they ever get seasick. Tao's dream is to see someone vomit underwater. I did not actually accomplish this, but the second I surfaced I started to vomit again. This continued until we got back to the land. The driver, giving me shit, said he was going to pull the dive master up right beside me. He kept to his word and almost on cue, I felt the intense urge to hurl again. Luckily I was able to hold it and did not puke in the dive masters face. Needless to say, I was not up for a second dive. It did make me feel a little better that even the hardcore divers in our group had not enjoyed that dive and were ready to call it a day.

We headed back to the house where we napped and read. Then headed down through the dune forrest to the beach.
The beach was beautiful and completely deserted. It was like our own private beach. As we started to walk though, we noticed that there were a large number of small dead black birds that had washed up onto the shore. The driver of our boat explained that he had seen these same birds floating out at sea. He believed that the storm had come in so fast and from a westerly direction that it had caught the birds and just pounded them. It was pretty sad, but I was relieved to hear it wasn't something in the water killing all of them!

While we relaxed on the beach, Jason, Fi and baby Alex stayed home to relax. Fiona found out during that time that this sign is not completely accurate. Turns out the monkeys will come in even if there is somebody in the living area. They came in a stole some cookies and crackers while Fiona stood helplessly in the kitchen. She eventually found something to throw at them and chased them out. She filled us in on the excitement when we met up with them on the deck of the bar later that afternoon. Here we partook in some fruity beverages and started our game marathon with some speed scrabble. We then moved it back to our place so we could get some food on the grill. The games were continued with an intense game of Jenga involving our dive master. After filling our stomach with yummy food we then concluded the night of games with few serious rounds of catch phrase. This has quickly become a popular game amongst the ex-pats.

The next morning, I really had to dig down deep and give myself many a pep talk before I was willing to pull back on that wetsuit. You can see below that I was pretty pensive and not sure about this decision. I was reassured that the ocean was more calm, but decided not to chance it and took a antinausea pill from the dive shop. Best decision of my life. We did two dives and I enjoyed both. In my limited diving experience, the corral in Sodwana is gorgeous. We saw a few of the loggerhead turtles and some manta rays. Either because I am new at diving or just easily entertained, I am still impressed by all the little things and was maybe most excited by a large purple starfish.

After two wonderful dives, our new found friend took us to this little backpackers where an Italian man makes pizzas in a small wood oven. Each of the pizza's were made to order and delicious.
Overall I think in the end this was a fairly successful and positive first dive trip for me!

Even when death is common place

2010-02-15T09:09:00.000-08:00

it still shocks and it still hurts. I was told by a coworker when asked how the weekend was that it had been very relaxing because she was able to be at home the entire weekend. There were no funerals she had to attend. My nurse told me last weekend that she had to cook and pay her respects to two different families in her community who had lost loved ones. Sadly, I think this is a routine way of life for most Swazis. It does not seem to dull the losses though.

Today, I had to tell our housekeeper that our neighbor's housekeeper had died. She was sick on Wednesday, went to the hospital on Friday and died Friday night. She left behind four young children. Thobile was devastated. She had become very good friends with this woman.

We recently lost one of our most active teen club members. He had been a patient at our clinic for years and was known by all the staff. He was always the life of the party. A tremendous loss was felt by his family at home, in the clinic and at teen club.

Sometimes as a doctor I feel completely helpless. I cannot imagine how these families, friends, and communities feel.

A Unique Family

2010-02-11T09:13:00.000-08:00

I have been working at RFM hospital full time for over a year now. Through this time I have become fully integrated into the hospital. I know the guards, the pharmacists, the x-ray techs, the surgeons, the orthopedists, the porters, etc, etc. I think though the people I am most fond of are the nurses on the children wards. Today in the weekly doctors meeting for the pediatric department, the chief reviewed the numbers for last year. The mortality rate for the childrens ward last year was 19%. Basically one in five children admitted to the wards will die. In the United States the mortality in pediatric hospitals is around is less than 0.5%. When I heard this I was not surprised. In the clinic we split time on the wards between myself and Dr. Lucia. At the end of a couple weeks, I always need a break because I am emotionally burnt out and frustrated. I realized today though that the nurses in the children's ward do not get that break. They are always there. They get attached to the patients and the mothers as much as if not more than I do. Yet they are the hardest workers with the best attitude in the hospital and possibly the country. I think it is thanks to their attitude that there is overall such a good feeling on the wards. There is an air of camaraderie and support on the wards between the staff itself, the staff and the families and the families themselves. Some of these children are there for weeks to months and within a room or cube the families are together 24 hours a day. Today one of the mother's came to our clinic for adherence counselling. When we do counselling before initiation of the HIV medications we ask for a treatment supporter to come. Who did this mother bring? Her mother, her sister, the father of her child? No, she brought her neighbor in the wards.

Like any family, we share the sad times, but we also share happy times. Just before the holidays this year, the mother of one of the internal medicine doctors got donors to contribute for a Christmas party on the wards. Below you see the organizer with Dr Kimba, my favorite doctor, and Nomile. Nomile had been brought to the wards by a church group because she was being neglected on her homestead. When she first arrived, she was malnourished and would not make any eye contact. She would not cry when you examined her, she would just sit there with her head hanging down. By the end of her stay, she had become queen of the ward. She would wonder from cube to cube, room to room. By the time she left she had many different mothers.

A group from a local orphanage was also included in the party.

The families all got more food then they could eat and all the children presents. The mood was definitely high that day.

Thanksgiving in Africa

2010-02-09T11:09:00.000-08:00

It is a little known fact that because Africa is in the Southern hemisphere Thanksgiving is celebrated in February instead of November. This is because of the different times of harvest. Alright, that is not true. I have just been such a delinquent poster that I am just now posting things that happened in November.

Michelle hosted Thanksgiving dinner for the second year in a row. Also for the second year in a row, Jason, this time accompanied by Paisley, cooked our four turkeys AND a turducken. The night before Steph, Michelle and I were tasked with the job of trying to get all four turkeys into brine water and into the refrigerator. Between Michelle, Steph and I we have three refrigerators, but they are all the mini ones and already full of other thanksgiving goodness. Steph wondered if maybe we could leave them outside for the night, but we were having quite warm weather at the time. I was afraid the entire ex-pat community might be out the next day with food poisoning if we did that. So the solution three doctors came up with...we realized if we took all the shelves out of Michelle's fridge in the garage the cooler, which could hold all four turkeys, was able to hang from the rungs for the shelves by it's handle. We were afraid however, that the handle would break so we felt we should prop up the cooler. Luckily, Michelle had the perfect piece of firewood for the job! We were quite proud of our ingenuity. And it paid off. Paisley and Jason did an amazing job with the birds. Everyone brought yummy sides. The turn out was great and as far as I know noone got sick.

It was our last holiday with the Vostrejs clan. We miss having them around!
But the first Thanksgiving for Gerhard (pronounced with a very gutteral G), the youngest resident of our condos. I think he was fan.

The sun sets on our time in Cape Town

2010-02-06T00:03:00.000-08:00

The first couple days we were in Cape Town there was cloud cover so we knew that Table Mountain was looming above us, but we were not sure exactly what it looked like. By the end of the second day I had reduced my expectations from climbing Table Mountain to simply seeing Table Mountain. Luckily for us, the day we had decided to climb Table Mountain, Christmas Day, was gorgeous. We had a nice Christmas breakfast then headed for the mountain. Josh and I decided that we would climb up while Mom and Dad took the cable car.
Looking up I hesitated briefly since I have not been very active recently, but Josh convinced me so off we went. The first part was straight up. Josh held up the conversation during this part while I huffed and puffed behind him trying to keep you. Then we hit a nice flat part and I took over the talking.
The final part was switchbacking up the side. Here Josh points out the "railing" along the trail. Pretty good incentive not to fall down the mountain when you realize not only would you fall a great distance, but you would be rolling through some barbwire. In truth the barbwire is truly there to keep you on the trail, but more to protect the mountain's safety (reduce erosion) than the hiker's safety. We finally made it to the top and we are proud to say that only one person passed us. I am sure Josh could have kept up with him, but he was a very good big brother and hung out with his sister instead. This was the typical scene though...Josh bounding ahead with me chasing behind.The view from the top was spectacular and well worth the hike.

On one side you looked right down onto Camps Bay the suburb where we had stayed. Last year on Christmas we got a great picture on our walking safari just after we had seen lions. We decided we needed another family shot to remember this trip. I asked a passerby to take a picture. I had her take a few just to make sure we got a good one. Unfortunatly I did not realized that my memory card was full so we only got one photo. Luckily the Hummert family is so photogenic the one photo turned out pretty well.

We all rode the cable car down which was an experience itself. We then headed home to relax at our apartment. We watched a beautiful sunset over the ocean before heading to a fabulous christmas dinner at a restaurant in Cape Town called Five Flies. Sadly the next day we had to get on the plane to head back to Swaziland.

Once we were back in Swaziland, we were lucky enough to get to stay at Uri and Jessi's fabulous house. That week I had to work so the family had to entertain themselves. They spent one night in Mkhaya, a great game park in the southern part of Swaziland. I got a taste of what it is like to be a parent. I realized as Dad was dropping me off that day that they should probably get a cellphone to have in case anything went wrong since they were driving. I got out of the car directing him to drive safe, watch out for potholes and gave him directions downtown to the lone cell phone network's store, MTN. My old phone had stopped charging a month prior so I had taken it in to be repaired. The phone was still under warranty so I was hoping it would be ready and they could just use that phone. After they were finally able to locate my phone, they informed my dad that the repairs would not be covered under the warranty, but there was a store that could do it for fairly cheap. Unfortunately, it was not going to be able to be ready that day so my Dad bought a black market phone. I still have it. It is a pretty good little phone. Luckily, I have had Nokia's before since I do not have the user's manual. Hopefully the rightful owner does not see me with the phone some day! After worrying all afternoon that they had made it ok, I finally called and was relieved to know everything was ok. I can only hope I will not be too neurotic when I have kids.

The last few days of their visit were very relaxed. The days consisted mainly of craft shopping. Then at night we enjoyed Jessi and Uri's house, cooking dinner, delving into our Cape Town wine collection and watching/finishing season two of "Arrested Development". Overall a wonderful trip and as always hard to see them leave.

Another Sh*t Day in Africa

2010-02-04T11:34:00.000-08:00

This is a pharse derived from a YouTube video that is used facetiously amongst my friends and I when we yet again find ourselves in some ridiculous place. This van captures the literal meaning of our jest and might sell tours a little better (depending, i guess, on who your target clientele is). On Christmas Eve day we started our tour of the cape by heading to the Cape of Good Hope. This is often thought to be the southern most point of Africa and the place where the Indian and Atlantic oceans meet. Turns out neither of these are true, but it is a very pretty place and has sign to pose so we went.

Josh and I did enjoy getting in the water until Josh cut his foot. We then had to do a little MacGwyver bandage job with a papertowel and hairband.On the drive to Cape Point, we passed this ostrich, which at first did not draw too much interest, until I decided it was pretty unique to see an ostrich with the ocean in the background.
Cape Point sits above the Cape of Good Hope. A top Cape Point sits the lighthouse that marks the end of the Cape Peninsula for passing ships. Because of vicious storms the coastline is littered with shipwrecks. On the lighthouse sits this pole marking directions and distances to various large world cities. Who knew that Sydney and New York were the same direction. I guess it doesn't say anywhere that it is pointing out the most direct route. The day ended with the highlight of the day: the Boulder Beach Penguins. Between my mom and I we have about 82 thousand pictures of the penguins so if anyone has interest in spending a week looking at penguin pictures I can hook you up. Here is just a small selection to wet your taste buds.

The day actually ended with a lovely dinner at a Maurikas, a cozy Greek restaurant in Camps Bay. I think we were lucky to get in because the rest of the place was filled with what appeared to be regulars. The chef himself came to explain the specials to us.

#312 Visit two island prisons that housed famous people

2010-02-04T10:09:00.000-08:00

Check. Although I guess Al Capone might be more infamous. I wonder how many people have referred to Nelson Mandela and Al Capone with the same statement before.

On our first full day in Cape Town, we visited Robben Island where Nelson Mandela had been imprisoned. Luckily, my friend Michelle had warned me to book for an early morning tour because when the water gets too rough they cancel tours. When we returned we realized that we were the last tour to leave that day. I would not have called our ride smooth either.

The tour was interesting and not what I had imagined. Although my expectations were all based on my tour of Alcatraz. The tour of Robben Island included the whole island with actually very little time spent at the prison itself. We learned that prior to the prison, the island was used as a leper colony. The leper cemetary still exists. The tour then focused more on the prison. We stopped first at the house of Robert Sobukwe. Robert Sobukwe was the founder of the Pan African Congress. He was seen as particularly dangerous by the government so was kept in solitary his entire time on Robben island. He had his own little compound. Behind his small house you can see the kennels for all the guard dogs. We then passed through the town for the guards and their families before heading to the lime quarry. We had the great pleasure of having Lioinel Davis, a former prisoner, on our bus who described the happenings at the lime quarry. The lime quarry was used for hard labour for the maximum security prisoners like Nelson Mandela. Papa Lionel though related that it was also a place of education. The prisoners would gather in groups with the more educated teaching the less educated. The South African government had allowed the prisoners to do courses through correspondence classes. Some, including Lionel, received their high school diploma while others who had come to the island with a primary level education left with a university degree from the University of South Africa. In the picture below just over the brush you can see the top of a cave. This was used as a latrine, but also as a place to pass on smuggled in newspapers or other materials. As long as the prisoners were not causing trouble most of the guards allowed these activities to continue.
Five years after his release, Nelson Mandela returned to Robben Island with many other former prisoners. At the lime quarry he picked up and then replaced a stone at the entry to the lime quarry. Other prisoners followed resulting in the below cairn. In Zulu, this is called iSivivane and marks a place where an event took place.

After the lime quarry, we saw some of the old world war II structures then headed to the prison itself. We got our tour of the prison from another former prisoner. He started in his cell block. This was a lower security cell block that housed many prisoners. By the time our guide was there, the bunk beds were in place, but prior to that prisoners slept on the cold floor on thin blankets.
The tour ended at Nelson Mandela's cell in cell block B. The bucket beside the bed was used as a toilet.

I almost got to experience a day in the life of Mandela when the bus taking us back to the ferry closed its doors and started to drive off before I got on. Luckily my mom made them stop for me.

Eat, Drink and Be Merry

2010-01-31T09:21:00.000-08:00

The first two days of our trip to Cape Town were spent in the wine country. We stayed at a cute little bed and breakfast. We had our own little cottage with two rooms that opened directly out to the pool. Every morning we walked to this nice little restaurant where we had breakfast.
After breakfast, the drinking started....I mean the wine tasting began. I was actually quite restrained during the wine tasting seeing as I was the designated driver for the trip. We visited three our first day. The first, Rustenburg, had a beautiful view of the vineyards with the mountains behind them.

The next winery, Morgenhof, is where I think we purchased our best wine....The Morgenhof Estate. We also enjoyed a lovely cheese plate here. The final winery on the first day was Simonsig. We took a tour of the winery here. We learned about how they make sparkling wine. They still turn the all the bottles by hand. We also learned that the wooden wine caskets and corks are all imported because the wood is too porous in South Africa.

After spending the rest of the afternoon reading and relaxing at the pool, we headed out to dinner at Terroir Restaurant at Kleine Zalze Winery. We made the reservation earlier that day and were told that they could fit us in, but that we would have to sit in the tasting room. This turned out to be a blessing in disguise. We had basically our own private dining room. The meal was amazing...definitely in my top five meals ever if not the best. I had Springbok which was delicious. The following day we visited the monument to the Afrikaans language. I had mixed feelings about going to this monument, but it really was quite an interesting monument. On the left as you walked up were three stone towers which represented Western European languages. This was connected by a bridge to the large tower representing Afrikaans.

The three half domes represent the African languages, which influenced Afrikaans.
We then visited Fairview Wineries, the home of Goats do Roam Wine. We were afraid we might be thwarted initially because there was a large accident in front of the turn to the winery, but thanks to the wonderful GPS from Dean we were able to find an alternate route. And when we arrived to our amusement the goats do roam around the winery. We added another bottle to round our collection out at six and an assortment of homemade cheese including goat chees.

We then bid Stellenbosch good-bye to head to Camps Bay in our cute little corolla.

You want to come to Africa again, huh?

2010-01-31T08:41:00.000-08:00

Well you will have to earn your keep this time. I did not hesitate putting them to work as soon as they landed. Mom and Dad came to clinic with me the first day they were here. They had brought a whole suitcase full of clothes to give to the children and families at the clinic. It is always very appreciated and the load went quickly over the holiday season. I did let them relax and have some dinner that night but then right back to work the next day.

The next day Dad rode down to Manzini with me to make sure that the kumbi (public transport) showed up to bring my kids to the christmas party and camp in Mbabane. My Dad was nice enough to volunteer to ride with the kids in the kumbi even though I told him it was not necessary. He then bragged that he had riden in a kumbi, but I told him it doesn't count if there aren't twenty people crammed in. His response, "they did turn off the tv when we started to drive". My response, "exactly. no real kumbi has a tv". Meanwhile my Mom was helping set up at the Christmas party (more on that in another post).

After working all morning, I did treat the family to a day at the Royal Swazi. Then later that night Fiona and Jason were nice enough to host us for a Christmas dinner. Jason prepared a wonderful meal of delicious turkey, mashed potatoes, sparkling wine, etc. Can't complain too much about eating Christmas dinner out on the porch in tank tops and shorts! The next day we left for our trip to the cape town area.

One day just doesn't seem like enough

2009-12-01T12:44:00.000-08:00

Another World AIDS day is about to pass here in Swaziland. As always I am at a loss for how to describe the impact HIV has in this country. I again was struck the other day as I was walking through the hospital how horrible it is to see so many young (20-30 year olds) dying. That is supposed to be the productive time of life. Losing this age group not only affects the children they orphan, but also their older relatives who now must raise and provide for these orphans.

A few updates:

First a happy one. A child that the last time I saw him I sent him to Mbabane government in a last ditch effort but in my heart truly believed he was not going to live. This is the child that had the growths all over his body. It did end up being Kaposi Sarcoma. I saw him a couple weeks ago after only two rounds of chemotherapy and the difference was amazing. He and gogo were beaming. Gogo said he was so excited when he walked in and said to her, "there's my doctor", which obviously made my day. Unfortunately the country is out of chemotherapy drugs so people only get them if the family's can afford it. His family could not afford any more than two rounds. Needless to say we have "found" funding for him to continue. Here is one before and after picture. Not only can you tell that the masses are gone, but he has gained enough weight back to have a bit of a belly.
I am sure all you guys will be glad to here that his groin is pretty much back to normal as well.

On a sad note, my sweet malnourished baby died. Just before I had left for the states, I had hospitalized her again for pneumonia. She had recovered and gone home. Then the Friday before I returned she came in with vomiting and diarrhea. Before she was even seen by the RFM doctor, she had died in her mom's arms. My guess is either it was pure dehydration or the child had gotten bacteria into her blood stream. She was such a precious girl.
The woman whom I believed had miliary TB has continued to lose weight (10 kilograms/22 pounds in three months) despite TB treatment. She is such a stoic woman and rarely has complaints that it has been really hard for us to figure out what is going on. We sent a viral load which was undetectable (meaning that the medications have completely suppressed the virus). It is likely an IRIS which just are unable to figure out what is causing it. IRIS (immune reconstitution syndrome) occurs when you start out with a very low CD4. As you start the ARVs, if there are untreated infections the patient can experience a ramped up version of the illness. Here the most common cause of IRIS is TB. We recently hospitalized her to give her high dose steroids to try to dampen the immune response. Dr. Lucia my colleague saw her yesterday and said she was actually looking improved.

Again, HIV/AIDs does not only affect those sick with it. It affects whole families. We had a 12 year old child in the hospital for over a month who was failing his first line of ARVs. Unfortunately by the time he came to us, his CD4 was down to single digits and he was already wasted. We switched his medications to second line, but he never improved. He continued to lose weight and become weaker and weaker despite every medication in Swaziland being thrown at him. Last week, I walked into the room to him moaning and it was just too much for me. He had gone from an already low weight of 50 lbs to less than 40 lbs. He had developed bed sores and was hallucinating. Previously when I would ask him, "Unjani? (how are you)". He would always reply, "ngiyaphila (I am well)". That day he said to me, "Ngifuna hamba ekhaya" (I want to go home). Through this entire stay, Gogo had been at his bedside day and night feeding him, changing him, giving his medications, singing to him. She had one of the most calming presences I have ever been around. I pulled Gogo and his mother out of the room that day and told them despite everything we were doing he continued to worsen and I was afraid he was dying. I gave my opinion that I felt like the most important thing at this point was for him to be comfortable. I gave them three choices: first stay in the hospital and continue everything, two go to an inpatient hospice hospital in manzini or three go home. The family at that point decided to stay in the hospital, but stop all medications except pain medicines. After this discussion, Gogo thanked me for my efforts then apologized to me for the situation. As she was coping with the fact that her grandchild whom she loved dearly was dying, she still was thinking of others. I was unable to speak for a bit for fear that I would not be able to stop the tears. The strength and love of these gogo's and extended family never ceases to amaze me. They in my eyes will be the heros that get the country through this crisis.

Let's hope real Team USA fairs better

2009-11-30T09:51:00.000-08:00

This weekend in conjunction with the World Cup coming through Swaziland FIFA sponsered a Mini Social World Cup. Never fear, the USA was well represented...well represented anyway. We had a great time although the scores might not reflect this.

It was quite a serious event. Each country was provided full "kits" or uniforms including jerseys, shorts and socks. There was also a full goalie outfit. We also each had our own locker room to prepare before the games. Our pool included Nigeria and the DRC. We started out against Nigeria, which was a really tough team. It seemed to be mainly young in shape twenty something who had played together prior to that day. Hmmm, practice...that is an interesting concept. We not surprisingly were the only team with any female team members and also a number of team members who had never played or not played in years. I was impressed though that the men were not at all afraid to get physical with our female team members.
Saturday night brought another great show from Oliver Mtukudzi, a Zimbabwean artist. His stage presence and energy combined with the energy of the crowd at his shows has made them some of my all time favorite at house on fire.

Want to have some fun?

2009-11-30T09:20:00.001-08:00

Then the Simunye fun fair is the place to be at the end of October in Swaziland. Luckily for me, it was my first week back in the country. The RFM clinic team had been making plans for close to a month to take a field trip. So Saturday morning, nurse Pinkett, her son and neice, Buhle and her son, Delisile and her daughter, Andwele and myself met up to drive the hour and a half to the sugar factory. Pinkett, being the team mother, had prepared an amazing lunch. We had to eat before going in because they did not allow us to bring any food in. The fun fair was equivalent to any county fair in the united states. There was expensive food, cheap toys and unsafe rides. The rides were possibly even more unsafe than the states because there was no restriction on who could ride any of the rides. Siwakhile, Buhle's son, was a ride fanatic. I am pretty sure he would have gone on the upside down ride with me if I had thought it was at all safe for him. Pinkett was worried her son, Donovan, would not have a good time. I guess this is always a concern at that preteen age, but I think he enjoyed the bumper cars and games as much as siwakhile.
Simphiwe, Deli's daughter, is one of the best natured and friendliest children I have met so she has fun wherever she goes.
By the end of the day, we were all hot, dirty and tired, but happy from a fun-filled day.
Despite the strong sun all day, at the end of the day I was still glowing white...or maybe that was the sun.
After leaving the fair, I joined up with a group at the rock lodge just in time for a lightning storm. What better place to be in a thunderstorm than in a lodge made out of granite? Needless to say we all survived.

No Excuse

2009-11-29T10:33:00.000-08:00

I cannot even come up with an excuse for why it has been so long since I have posted. It is just pure laziness on my part. I will try over the next few days to get everyone caught up on the last month. This post, however, is from the first weekend of october before I even came home.

Our housekeeper invited us to a traditional Swazi wedding. When we arrived at the wedding, Thobile first took us to the area where the groom's family was preparing food. We briefly helped serving food to the guests before Thobile took us down to the river where the bride's family was getting ready. The bride graciously welcomed us. Thobile quickly helped us get ready then had to leave because she was on the groom's side, which left us with a bunch of strangers of whom only a few spoke English. We did make friends with one woman who then the remainder of the ceremony tried to help us understand what was happening. Below is a picture of an elder of the bride preparing the "ring". In Swazi culture the rings are actually a calf and goat gallbladder which is inserted into the bride's hair. There was then a brief song and brushing of everyone's feet before the procession to the groom's homestead. In the front of the procession, was a young maiden carrying the bride's blanket and possessions on her head as the wife would now be staying at the groom's homestead. Once we arrived at the homestead we processed through the cattle kraal. I am not sure the symbolism of this, but the kraal is involved in the first part of the marriage as well. As far as I can gather the Swazi wedding occurs in three steps. First, the bride goes to the groom's homestead with him. She is awoken by his family members early in the morning. She is to come out of the hut and clean the cattle kraal topless and crying. If she does not cry this is insulting and so she is then insulted by the women of the groom's family. This is what I have interpreted anyway from what people at work have explained to me. The second part is called lobola. This is where the grooms family presents traditionally cattle (sometimes now money) to the woman's family. The number of cattle depends on the birth order not surprisingly the class or education of the woman. The final part of the wedding is the ceremony which were participating in this day.

Following the procession through the cattle kraal, the dance marathon started. The bride and the female members of her family literally danced for close to two hours straight. The women dressed in the cloth and black skirt are married or have children. Below is a picture of the maidens. The groom and his brothers also joined in for some of the dancing although the majority was the women. Below is the bride with the groom to her left surrounded by his brothers. At one point, we were pulled into the middle to dance. Obviously everyone got a kick out of this. Here one of the groom's brothers had handed me his shield and club. It is quite possible that after that I am promised to this man. As with any wedding, in addition to dancing there was also drinking. Thobile let us try a sip of the home brew. It was not horrible, but a little chunky. I am not sure how much I could actually drink of it. Here a man had recycled a beer bottle into a homemade vuvuzela (the soccer horns). Somehow in the midst of all of this, Tini and I had caught the eyes of the Mnisi brothers. One insisted on writing his number of Tini's hand. The other just preferred to stand very close to me while professing his love. We unintentionally captured him in the picture below. The wedding ended for us (before the actual party even began) with Thobile escorting us to the car saying, "quick. get in and lock the doors". Never had a more exciting exit from a wedding.
It was great day and fun to see Thobile together with her whole family.