Coming to an End

I made it! Both sadly and happily, my time in Manguzi has come to an end.  When I landed in Durban 4 weeks ago, it felt like this day would never come.  Now, I can’t believe I am actually leaving. I’m sorry I haven’t written many posts this week. It was a busy one filled with lots of medicine, friends, and goodbyes. 

My last week at the hospital definitely had its ups and downs.  We had some great evening braiis (barbeques) with all the doctors, but some rough times in the hospital. I’ll try to sum up a few of the more memorable moments. Perhaps a good one and a bad one.

The limited resources available at Manguzi were a frustration every day, but I felt that, the majority of the time, we were able to work around them.  In fact, I was consistently impressed by how many diseases you could treat with just basic knowledge and sometimes a little innovation.  It’s certainly very different from how we practice medicine at home. Wednesday was the first time that I saw the direct impact of these limitations on a patient’s life, and it was a very difficult lesson.

I was taking care of a 2 month old baby who came in with what looked like a severe pneumonia.  During rounds in the morning, he was ill, but definitely stable. Around 4 in the afternoon, I happened to be walking by the peds ward and one of the nurses came running out to ask me to help with the baby.  He was having a very difficult time breathing and was wearing himself out trying to get enough air.  I put him on oxygen and started fluids and ran off to get help.  We gave him some medications, but what he really needed was to be intubated.  In the states, we see plenty of babies who get such a severe respiratory infection that they require assisted ventilation for several days, but once the infection is cleared they are able to come off the machines and be healthy babies again.  Unfortunately, we didn’t have a ventilator at Manguzi, so the only way we could intubate the baby was if we knew that transport from another hospital was on the way to transfer him to an ICU.  The attending on call, Eva, said that she couldn’t call any regional hospitals about transport until we got some stat labs.

While she ordered the blood tests and made some phone calls, I stayed with the baby.  His breathing got progressively more difficult and it was horrible to watch.  Standing by in a situation like that, you know the baby can only breathe that way for so long before he tires out and can’t breathe at all.  I wouldn’t have thought that a 2 month old could look scared, but his eyes were terrified.  And he looked straight at me, holding onto my finger, for 3 hours.  It was heartbreaking.  When the on call doc came back, she told me he would not be transferred.  I was shocked. And devastated.  But mostly confused.  Eva explained to me that the baby’s rapid HIV test had come back positive.  Because there are only three ventilators available for the entire region, they have an endless list of exclusion criteria for who can be placed on one.  Their rationale against our baby was that, because he was HIV positive, he was more likely to have an infection with an unusual bug and therefore less likely to come off the ventilator quickly.  They needed to save it for someone who would be more certain to benefit from it in the long run.

Although I understood the reasoning in the setting I was in, that didn’t make it any easier.  And to be honest, until I was able to step away from it later and think things through, I was furious.  I couldn’t believe a 2 month old was not even going to get a chance to live.  When his little lungs took their last breath, there was no resuscitation.  A resuscitation is supposed to be a bridge to intensified medical care, and that was something we couldn’t offer.  Sadly, the physicians at Manguzi see cases like this all the time, so Eva was not too upset by the situation.  It was pretty traumatic for me though.  It reminded me that, no matter how willing you are to help and how hard you try, you are still subject to the constraints of the culture and setting you practice in.  I think that would be the hardest thing for me about a career in international medicine.

So Wednesday was not my best day.  But Thursday was a great one.  Tom, the doctor I’ve been doing pediatrics with all this time, had only two hours in the morning to see patients.  He asked me to see the rest of the patients on my own, and told me that he trusted me to make the correct decisions on their care. I rounded on patients, gave nursing orders, called consultants, and discharged the kids who I thought were ready.  I ran it all by him, but he didn’t make a single change to what I had decided.  I felt like a real doctor! Having all that responsibility made me both excited and terrified to start intern year.

Thursday night they had a big goodbye party for us.  We bought lots of steaks and grilled out by the pool with all the doctors and physical therapists we have been working with for the last month.  It was so much fun! We were surrounded by good music, fresh pineapple, and lots of new friends.  Doesn’t get too much better! We were having so much fun that we stayed up til 1 a.m. Not that impressive at home, but here we call 9:00 Manguzi Midnight.  Needless to say, none of us were looking too perky at morning conference on Friday.

Friday afternoon, Bryan and I rode with two of the doctors to a small beach town just north of Durban.  When we were making reservations, all the cheaper bed and breakfasts were full, so we ended up booking one that was a bit more expensive.  It is super nice!! We went and got some “take-away” and then came back to the room to soak up the glory of being back in civilization.  Air conditioning for the first time in a month when temperatures have been upwards of 90. A bed that does not have mattress springs poking me through the top.  No mosquito nets.  A shower I can use without flip flops.  Water I can drink.  The list goes on and on. 

This morning, after a delicious homemade breakfast at the inn, we set off to Durban Centre.  Had I not spent a month wandering the markets of Manguzi it might have made me nervous, but the number of things that make me nervous these days is much smaller than it used to be.  We ended up at a large street market in the heart of a busy, gritty, very urban downtown.  Bryan and I spent the next two hours loading up on souvenirs.  The street market was awesome! There were tons of vendors selling all sorts of handmade African crafts…everything from baskets to jewelry to paintings.  We met up with our friend Jonas from the first two weeks at the hospital.  He and Bryan had a grand old time haggling with the vendors.  It was pretty funny to watch, and since I hate confrontation, I let them negotiate my prices for me.  Good thing I left so many sheets and clothing in Manguzi to make room in my suitcase for everything I bought.

We then met up with Sanushka, a doctor from Durban we met, and she took us to lunch at one of her favorite Indian restaurants.  Durban has the largest Indian population outside of India so they are very well known for their curry.  After lunch, Bryan took off for the airport and I am now alone for the first time in a month.  I have to say, it is kind of wonderful.  I took a nice long walk on the beach, had a good long Skype conversation with the parents, and treated myself to a nice dinner.  The glass of wine they brought me was big enough to knock me out for the night! I was pretty excited to find out that the restaurant I chose had ice cream sundaes. I haven’t had ice cream since I left home and have been craving it like crazy with this heat.  They brought it in a giant bowl and I ate every last bite!

Tomorrow, it’s off to Spain! I’m so excited to tour a country I’ve always wanted to go to with one of my best friends.  Should be an amazing 10 days! I will try to post at least once or twice while I’m there.  Thanks to everyone for being so incredible and supportive this month! Your emails, Skype conversations, and comments on my blog allowed me to smile and have a positive attitude every day.  Without all of your encouragement, I would not have even thought about tackling such a big adventure, and now I can’t imagine what my life would be like as a doctor without all the things I’ve seen and learned this month.  So thank you, because every one of you helped me get here. 

Here are some random photos to enjoy!

Another Jayhawk makes an appearance :)

Our last night braii

Me with the physios (aka PT, OT, and speech)

Boat Racing...the South African version of Flip Cup

Our last day :(

Entrance to the hospital (probably should have posted this one a while back)

Cool close up from Jonas' ultra-zoom camera

Zulu for a Day

When planning our month in Manguzi, we did not expect to stick around for any of the weekends.  There is so much to see and do nearby, and none of us knows when, or even if, we will make it back to Africa.  Once we laid eyes on our rondavel and learned that the small number of shops nearby are actually not even open on the weekends, we became even more determined to escape as often as possible.  This past weekend, however, we were disappointed to find that everything we had wanted to do was booked. It looked like we were going to be stuck for the weekend.

Lucky for us, it turned out that the biggest Zulu festival of the year was this weekend.  It’s called the Amarula Festival and it is thrown by the Tembe tribe of Zulus.  The amarula is a fruit that grows on trees in South Africa.  Apparently, at around this time every year, the Tembe king declares that the fruit is ripe and ready to be turned into an alcoholic beverage.  (I would be more specific if I could but, even after tasting it, I’m not sure whether it falls in the beer, wine, or liquor category.)  He then sets a date for the festival and members of the Tembe tribe come from far and wide to join in the celebration.  The nurses were talking about it all week.

So, Saturday morning, the four of us and one of the dietitians headed out with high hopes, but really no idea what to expect.  We saw our first truck-full of debauchery at a gas station about two minutes from the hospital and figured it must just be one big party and a good excuse for getting drunk.  On the half hour drive there, we passed several trucks with no less than 15 people in the bed.  When we put on our blinker for the turn onto the back road to the festival, one of these trucks was in front of us.  They all looked perplexed for a minute, and then when we actually completed the turn and continued to follow them, they broke out in laughter and cheers.  That perhaps should have clued us in to what was to come.

We parked and set off to find the enormous tent the nurses had described.  What we found was thousands of Zulus surrounding a fenced in stage upon which the Tembe king was speaking.  We were hardly inconspicuous seeing as we were THE ONLY white people there, and our arrival caused some head turning and whispering.  Inside the fence were a group of men, women, and children all dressed in beautiful, traditional tribal costumes.  Though I couldn’t understand a word the king was saying, I could tell he was a captivating speaker.  He had an impressive presence onstage and a booming voice which was frequently echoed by cheers from the audience.  About two minutes after we arrived on the scene, a security guard asked us to come into the fenced off area.  She said a man on the other side wanted to see us.  We weren’t too sure about this idea, but we didn’t want to make a scene while the king was speaking, so we followed her.



Hundreds of people outside the fence listening to the king



On the other side, there was a tent we hadn’t paid much attention to up til now.  The man led us inside and asked us to please find a seat.  It took a few minutes with each of us gathering our own bits of information, but we discovered that we had been invited to join in a feast.  It was a different crowd inside than out.  They were all well-dressed, educated, and comparatively very wealthy.  There were not a lot of empty seats left so we each ended up at different tables.   After talking to my neighbor at my assigned table for several minutes, he asked me if I knew who I was sitting with.  Of course I had no idea and I told him so.  He then informed me that all the men I had been making silly small talk with were the presiding chiefs of the Tembe tribe.  Humbled and feeling a bit awkward, I continued to eat my meal (which was quite delicious) with them for the next two hours.  I later found out that my neighbor was actually the prince!! Something he had failed to mention, but gave a bit of explanation to why he kept asking me if I wanted to be the new Tembe princess. J

The Tembe chiefs

During our meal, there were a variety of Tembe songs and dances performed on stage.  It was quite amazing to watch everyone do the traditional dances in full costume.  I could have watched all day.  One of the men at my table told me that, at any given time, there is only one person who is allowed to sing for the king.  To me, this singing sounded like really fast talking, but apparently it is a great honor.  As this particular singer is getting old, he is currently training a young boy who will take his place after he is gone.  It was really incredible to see the Zulu people (many of whom I may have seen at the hospital or clinic) in their element, to be a guest in their culture, rather than the other way around.  I think, by the nature of our work, we are forced to spend much of our time feeling sorry for the Zulu people ; it was a refreshing change and a privilege to see the people and their culture celebrated as it should be.

Me and one of the Zulu men in full traditional dress

After the formal celebration ended, things got a bit crazier! Despite the fact that this was supposedly the Amarula Festival, we had yet to see any amarula…just lots of people displaying the effects of it.  Brett and Bryan decided it was unacceptable to leave without a taste of this mysterious drink, so we went off in search of it.  Now, you would think, that as the namesake of the festival it would not be hard to come by.  In fact, it required quite the treasure hunt.

The farther we walked from the stage, the drunker people got.  I used my extensive ten word Zulu vocabulary A LOT in the next hour.  EVERYONE wanted to stop us and talk to us.  I’m not sure if they found our presence amusing, exciting, or if perhaps we were just a novelty that everyone wanted to say they had met.  Regardless, we were very popular that afternoon.  Not only did people want to talk, but they wanted to dance (and teach us the moves), share drinks, and take pictures.  My goodness did they ever want to take pictures.  It didn’t matter if they were man, woman, young, old, drunk, sober…everyone was grabbing us and pulling us into the pictures on their tiny cell phones.  I don’t exactly know what you would google to find it, but I’m pretty sure you might now be able to find us on the internet.  

Some of the less sober members of the celebration

Eventually, we stumbled upon the Holy Grail, or rather the world’s largest barrel of alcohol, on the king’s property. It was roughly 12 feet tall and 8 feet in diameter with a line at least 30 people long extending from it.  Everyone in the line was holding not cups, but 5 gallon jugs to fill with amarula.  Bryan and Brett got in line and quickly got singled out to come to the front.  The line was less than happy about this so they filled their jugs quickly with what looked more or less like dirty water.  They both took a big swig, and after seeing their reaction to this, I did not feel the need to sample it myself.  One of the girls actually spit it out hoping that no one would see.  As we walked back to our car, the people we passed were in progressively less sober states of mind.  Not wanting to drink anymore amarula, and not sure what the everyone’s extreme interest in us would become with the addition of large amounts of foul-tasting alcohol, we decided it was time to go.

The keepers of the Holy Grail

The moral of the story, I guess, is that amarula is not all it’s cracked up to be, but the festival is pretty impressive.  The day as a whole was an interesting glimpse into a culture that, until now, I had experienced only from the outside.  It really made my time here come full circle, bringing me from complete foreigner to participant in local culture.

Bryan and his precious (or not) Amarula

The weekend was otherwise unremarkable.  It pretty much rained the whole time and we spent far more time than desired in the rondavel, leading me to coin the term “rondavel fever.” We did tackle making smore’s last night which was amusing and delicious.  We used sweet biscuit crackers, chocolate bars, and flavored marshmallows.  Bryan was quite impressed with himself because he managed to use both matches and charcoal that had been rained on all weekend.  Not two minutes after he got the match lit (in the toaster!!) it started raining again. L So we moved the grill under our VERY small awning and the four of us sat around it toasting marshmallows on butter knives.  And the moral of that story is that, no matter how badly you try to mess it up, the combo of marshmallow, chocolate, and sweet crackers is ALWAYS delicious!

Chocolate+marshmallow+fire=just like home :)

Only 3 more days in Manguzi, then a weekend in Durban, and off to Spain!! I’ll try to get one more post up before I leave here.  Miss you all!





A Thousand Words

They say a picture is worth a thousand words.  For me, the pictures I have taken of the children here are something I will cherish for the rest of my life.  Each child has their own story and I know that, years from now, I will be able to look at these photos and the story will be as clear in my mind as it is today.

I’m sorry if I’m sounding overly sentimental.  I’ve been pretty homesick the past few days for the first time since I got here.  I think it’s probably just a halfway slump…I’ve been here long enough to really start missing everyone back home, but I’m not quite close enough to the end to start counting down the days.  On the other hand, I am really sad about the thought of leaving these kids.  I thought when I came here that I was going to work on a different ward each week, but I’ve become so attached to my little patients that I haven’t been able to bring myself to do anything but pediatric rounds.  I even find myself going over in the evenings when I’m bored to see how they’re doing.  It’s probably a good thing that South Africa doesn’t allow international adoptions or I might be coming home with a few extra carry-on items. J

I’m hoping that, with some short descriptions, these pictures and the children in them will move you as much as they do me.

These little boys are my soccer playing buddies that several of you have asked for pictures of.  The one in the bed has a fractured femur, so there’s no kicking for him.  He’s the one that I accidentally “headed” the ball off of the first day so that’s how he contributes to the game.  They are both 7 and think everything I do is absolutely hilarious (which it’s usually not, but it’s nice that they think so!).  It’s especially great to hear the other boy giggle because the first two days he was here, he wouldn’t talk to anyone and cried all day long.  It broke my heart.  We sent him home yesterday and he was a completely different kid than the one who came in…running at me to give me a huge hug before he left.


Bryan’s mom sent him a package that (somewhat miraculously) not only got to the hospital, but arrived while we were still in the country.  It was full of Jayhawk memorabilia…we had to make sure everyone in Manguzi knew which team to root for come March.  There were hundreds of Jayhawk stickers and Bryan gave me the job of passing them out on the pediatrics ward.  Turns out, the kids love them! It’s funny because they don’t really understand the concept of stickers and they all shrieked in amazement when I stuck the stickers on them. Now they want new ones everyday which is probably good seeing as we have an endless supply.


Another apparently fascinating item is the camera.  I brought mine in the other day to take these pictures and the entire room, including the moms and nurses, gathered round.  Everyone could hardly wait to see the picture after I took it…thank goodness for digital cameras.  Then, they all wanted to try taking pictures.  Unfortunately, the concept of seeing what you were taking a picture of on the screen never really seemed to catch on.  Therefore, this picture is actually the best of the series despite the fact that it contains only 1.5 people.  My camera lens probably could have done without so many grubby kiddy fingers on it, but it was worth it to watch the thrill they got out of the “click” of the camera.


I hate to play favorites, but supposing I were to have a favorite, this little guy would be it.  We were best buddies for the week he was on the ward.  The first few days he just played with me when we came into his section of the ward.  The last couple days though, he came toddling to the front door as soon as he heard my voice in the morning and stayed with me for most of rounds.  He was like my little shadow just prancing along behind us.  Every ten minutes or so, he would tap my leg and want to be held for a bit.  I put my stethoscope around his neck yesterday and told the moms that he was the new doctor.  That seemed to put everyone in good spirits, and actually made his mom smile for the first time.

This is the same little guy with his partner in crime who was there for two days.  They are trouble makers!! They were into absolutely everything, including the doctor’s cart.  I’m not sure what I was thinking, but I showed them that if they banged on different parts of the metal cart it made different noises.  So they proceeded to bang on it for the duration of round, and that’s what they are doing here.

This one almost ended up in my suitcase as a stowaway.  You can’t tell from this picture because he was so much better, but when we admitted him he was so dehydrated and malnourished that he looked like Benjamin Button.  It was amazing how quickly he turned around and plumped up once he was getting proper fluids and feedings.  Even when he was sound asleep, if I put my finger near his hand, he would find it and hold on tight until I pulled it away.

Although I have loved every child I have cared for here, this little girl is the one who has left the most profound impression on me.  She, and other children like her, are the reason that I will come back to Africa.  She is the sickest child on the ward and has been here since long before I arrived.  She is seven years old and, except for one or two days that her GoGo (grandma) visited, has been by herself in an isolation room the entire time.  The rooms don’t have toys, or tvs, or books.  Every day, I am in awe of how brave she is.  Of all the injustices I have seen here, the one that is hardest for me to stomach is that there are children who have to die alone.  That’s just not something you see in the U.S. and we are so lucky that is the case. I spend a lot of time with her, just sitting and talking.  It’s funny because we both talk in our own language which the other doesn’t understand, but somehow it is still comforting for us both.  Yesterday, I saw her cry for the first time since I’ve been here.  She was having trouble breathing and got really scared.  Bryan’s mom sent one little stuffed animal Jayhawk to give to a kid, and at this point I decided she definitely deserved it.

I told her (with a translator’s help) that if she could be brave through lunch time, I would bring her a present after lunch.  She looked confused, but smiled.  I wish I had a picture of the exact second I gave her the doll because it was, for lack of a better word, miraculous.  For the next ten minutes, she looked like a happy, healthy child who had lived a normal life.  She made the little Jayhawk fly and dance, and was grinning from ear to ear the entire time.  I told her that the Jayhawk’s job was to take care of her and make her happy.  Somewhere, part of that got lost in translation, and she now thinks the Jayhawk’s name is “Happy.” This turned out to be a wonderful thing though because now, every time I visit her, she is singing to him “happy, happy, happy” “happy, happy, happy.” I have a video of this but the internet here isn’t fast enough to post it.  She is an incredible girl, so please send your good thoughts and prayers her way!

Well, I guess this post turned out to be a picture AND a thousand words, but I hope it gave you all some insight into what my days have been like here.  A child’s capacity for hope and happiness in the face of so many hardships never ceases to amaze me…just one of many reasons why I am so excited to become a pediatrician.

Crossing the Border

Almost every person we’ve asked about what to do while in Manguzi has mentioned spending a weekend in Mozambique.  So, this past weekend, we decided we would do just that.  It is only about a 20 minute drive to the border from the hospital.  Some of the group wanted to just walk across the unpatrolled border on the beach, but after our disastrous Thursday evening, I wasn’t feeling too optimistic about a long evening hike in another unknown and sparsely populated area.  Plus, I figure it’s generally better to err on the legal side when in a foreign country. So, we decided to just fork up the money and pay to cross.

Luckily, I happen to be traveling with a few pretty smooth talkers.  They convinced the immigration officers to charge us half price since we work at the hospital.  I guess this is fair enough, since a large number of our sickest patients actually come from Mozambique. Surprisingly, the ride our motel had promised us from the border was actually waiting for us when we arrived.  Also surprising was that our ride did not fall apart over the course of the next 45 minutes.  Back home, I don’t think you would find a jeep like this one anywhere but a junk yard.  I could see far more of the inner foundation and workings of the car than I think was probably safe.  I have never experienced “roads” quite like the ones that took us from the border to Ponto D’oro where we were staying.  A picture is probably better than any description I can give.  Oh, and our driver only had one eye to navigate all this with!



The "road"



I have to say that Mozambique is much more a picture of the Africa I envisioned than South Africa is.  The scenery on our drive in was amazing.  Rolling hills, vast plains, and trees everywhere.  It is also significantly poorer than South Africa.  Although the houses around Manguzi are roughly the size of a bedroom in Kansas, they are at least houses.  Most of the people in Mozambique live in shacks or lean-tos. It’s amazing that there can be such a discrepancy within just 30 miles.

 

The houses in Mozambique

We arrived at our motel to find we were staying in a cabana not much different from our rondavel.  The view from the balcony more than made up for the not-so-quality accommodations.  I think it took all of five minutes before we were on the beach.  The water was pristinely blue and we were excited to set foot into the Indian Ocean for the first time.  Sadly, within about 30 seconds, we were all running out of the water, arms and legs flailing.  We had all been stung by jellyfish.  We had been so entranced by the beauty of the water that we hadn’t even noticed the thousands of small jellyfish washed up along the beach.  I guess I had just kind of assumed they were seaweed.  They were quite small so the stings weren’t bad, but they were enough to discourage anymore swimming for the weekend!!



Those are ALL jellyfish

We managed to get a walk down to the cliffs and back in before it started to rain, and then ducked into a beachside bar for a few local beers.  After it cleared up, we wandered out in search of dinner.  There wasn’t a lot to choose from, and for some unbeknownst reason, everywhere was out of fish.  Not being a seafood lover myself, I didn’t mind too much, but the others were quite disappointed.  Understandably so since we could see the ocean from the restaurant window.  They finally settled for a place with prawns.  Personally, I can do without eating things that still have eyes. 

The next morning, we headed straight for the beach after breakfast.  Being the naïve Americans we are, we thought we would avoid the strongest sun by going to the beach early.  After an hour and a half, and with it not yet being even 11 a.m., we were all lobsters.  Somehow, each of us managed to burn a different part of our bodies, so we made quite the odd-looking quartet walking around the rest of the weekend.  The tops of my feet and my knees took the worst of it.  I also am now sporting the coolest watch tanline you’ve ever seen.

We spent the rest of the day exploring the town.  There are stands everywhere selling just about anything you can imagine.  We were pleased to find our first coconut that the seller was actually willing to crack open for us.  Fresh coconut meat is pretty tasty! Towards the end of the afternoon, we had a storm that would have rivaled some of Kansas’ best.  It was absolutely pouring and I thought the wind was going to take out our cabana.  It didn’t last long though, and when it was over, the view over the ocean was breathtaking.

 

For dinner, we let Brett lead us to a little hole in the wall restaurant he had discovered earlier in the day.  I have to admit, I was a bit skeptical, but it turned out to be a great find.  There were only 3 tables in the restaurant and the owner was cooking all the meals himself, but it actually had more customers than most of the other places we walked by.  We soon found out why…the fish was amazing!! And not just because he was the only place to actually have fish.  Bryan said it was the best fish he’s ever had.  It was definitely a fun way to spend the evening.

Sunday morning we did our best to stay out of the sun.  Luckily, it was pretty cloudy. The rain had washed away all the jellyfish, so I bravely set foot in the ocean one more time for the sake of capturing it on camera.  I escaped unharmed. J Our one-eyed driver returned as scheduled to take us back to the border, and the remainder of the day was relatively uneventful.  Despite the rain, Mozambique was definitely worth the trip.  Next time, I’m going back in December when the sea turtles are laying their eggs! 

 

Me enjoying the Indian Ocean while avoiding the jellyfish :)





During the storm

 

After the storm





LOST!!

Well, it’s been quite a bit longer than I intended since my last post.  Thursday and Friday were a bit hectic, as I will describe in a minute.  Then, we were gone most of the weekend without internet and, when we finally returned home last night, we didn’t have any power.  So prepare for a long post.  I have quite a few stories to share!

There are few things that scare me more than being lost. One of those few things is being lost in the dark.  On Thursday night, I discovered something new that tops the list…being lost in the dark in the African jungle. 

Our friend Jonas heard about Manguzi hospital through a friend of a friend who happens to be a pastor in Manguzi.  The night Jonas made German schpaetzl for everyone, he invited the pastor, his wife, and the child they are caring for to join.  They seemed like nice enough people, but a little odd.  They offered to take us to Kosi Bay, a place not too far from Manguzi where a series of lakes joins up with the Indian Ocean.  They told us it would be a short hike into the bay from where they park and then we would be able to snorkel and have snacks on the beach before coming back.  Sounded like fun to me!



Bryan and I before we knew what we were getting into



On the drive there, I began to wonder just how normal these people were.  The woman went on a ten minute tirade about how the Zulu medicine men are working for Satan and trying to kill the human race.  Now, I agree that some of the plants they use can be quite toxic, but the Zulu medicine man is a tradition that is hundreds of years old and a well-respected leader of the Zulu people. Perhaps there are some who are not as well-meaning as others, but I am doubtful that they are trying to destroy all of mankind. If so, they haven’t been very successful considering how long they’ve been around.

When we arrived at the park, they parked the car in a random field which I found a little strange.  Turns out the whole reason we were hiking in was to avoid the 20 rand (~$2.50) entry fee.  It didn’t bother me at that point though because a short hike sounded nice and like some much needed exercise.  The first stretch was straight up the side of a hill.  The view from the top was breathtaking, but also enlightening.  There was NO WAY a 30 minute hike was going to get us to the ocean, which we could just see at the end of the horizon.  We walked for about an hour and a half on a path made of sand and no more than a foot wide. It was not easy walking.  I was lucky to be wearing my tennis shoes, but others were stuck making the trek in flip flops.



The ocean in the distance

Eventually, we reached water.  Unfortunately, the water on the opposite side of the bay was somehow better, according to the pastor.  So we trudged through water up to our thighs (most of us not yet in swimming suits), then climbed straight up and over a piece of land that jutted out into the bay.  Since I had taken my tennis shoes off for wading, I did this portion barefoot…not a good idea. On the other side of this land, we finally reached the appropriate destination.  There were only three sets of snorkeling gear; the pastor, his wife, and Jonas got them and took off into the water.  The rest of us sat on the beach for a bit and enjoyed what was actually a very beautiful view.  After less than 30 minutes, they returned and told us to hurry and pack up our stuff because it was getting dark.



Near: the beach we arrived at, Far: the beach they insisted was better



That should have been my first warning sign.  Instead, about 5 minutes into our return hike, I heard the pastor say “Oops, we’ve gone the wrong way,” and THAT was a very clear warning sign.  Within ten minutes it was dark.  Not just nighttime in the city dark, but moon behind the clouds in the African jungle dark.  As we walked along the water, we began to see hippo poop everywhere.  At this point I should probably tell you that, in our entire packet we received about South Africa, THE ONLY safety warning was this: “do not get between a hippo and the water at sunset.”  Well shit. When I asked the pastor’s wife about it, she said “oh yes, they are certainly the most dangerous animal around.” My follow up question about what to do if we saw one was answered with a bleak “I’ve no idea.”

As you all know, unfamiliar situations are not my strong suit.  By this point my mind was racing.  I didn’t know whether I was more afraid of being lost, trampled by a hippo, or bitten by one of the poisonous snakes who live in the bush (aka jungle).  “Just don’t walk in the bush,” the pastor told me.  This was exceedingly unhelpful seeing as the sand we were walking on, single file, was the only thing in sight that was not bush. Thank god, two of us had thought to bring flashlights.

I could give you a play by play of the next hour and a half, but it mostly consisted of the four of us getting increasingly anxious as the pastor got more and more lost.  He kept stealing our flashlights to look for the turnoffs he had missed.  Then he would walk really fast ahead so none of us could see a thing, including where he had gone.  At least four times we had to turn around and retrace our steps before branching off in another direction. Basically, to sum it up, it was the most scared I have been in a long time, possibly ever.  When we came around the final corner and I saw the truck, I could have cried I was so relieved.  It was a very quiet ride home.  I think we were all biting our tongues to keep from speaking what was on our minds which was, unanimously, “if you offer to take four tourists on a hike through the wilderness, either know where you are going or do it before dark.”



My camera died before darkness set in, so here's a less frightening picture to enjoy



Well, this post turned out to be quite long.  I think I will go ahead and post it along with some pictures for everyone to read while I work on another post about our weekend in Mozambique.  Should have that one up by tonight U.S. time.  Hope everyone is well!

Manguzi Medicine

Before I left for Africa, a good friend gave me a necklace with an inscription on it that reads “All the strength you need is right there inside you”.  I can’t tell you how many times I looked down and read that necklace today.  At least a hundred.  For better or for worse, my experiences here the past few days have forced me to find a strength I didn’t know I was capable of.  I have actually been avoiding writing a blog because I didn’t want it to be too sad.  But then I realized that it is all part of my experience here at Manguzi, and should be remembered and shared right along with the good times.  I promise not to dwell on it too long during this post, but I do want to share a glimpse of what medicine and life is like for some people.  It is a true blessing to live in a country where, despite the current health care crisis, anyone can walk into an emergency room and receive quality, life-saving care when needed.

Today, I saw my first “active” death.  Not someone who had been ill for a long time and was known to be dying, but someone who was well yesterday and arrived at the resuscitation unit in critical condition.  He was 17.  Although all of the doctors here are smart, well-trained, and passionate about their careers, there is nothing that can substitute for experience when faced with a true emergency. Unfortunately, although many doctors come here to do their required year of community service just after finishing their training, Manguzi struggles to keep anyone after that year.  This means that the majority of the staff have, at most, 1-2 years of experience treating patients on their own.  This particular patient would have died no matter what, but it was scary to see how slowly things moved in a crisis situation.  It makes me realize that, while I may have learned more than I thought possible the past two years, I still have a long ways to go, as does most of the staff here. In my four years of medical school in the states, I have only had one patient die unexpectedly.  In the past 24 hours here, I have seen it twice. It has been sobering, for lack of a better word. 

Practicing medicine here has also made me realize how much there is to be grateful for even in the most inner city hospital in the states. Yesterday, I looked for 45 minutes to find a functioning otoscope so I could be certain a patient had an ear infection before I wrote for antibiotics.  It is a daily gamble whether or not the nurse assigned to your unit for the day will be even remotely competent.  There are a few fantastic nurses, and it is amazing how much better the day goes when you are paired with them, but most are not even slightly interested in doing their job. The patients are actually responsible for carrying around their own medical records here.  This means we have to rely on them to have their papers on them to have any sense of their medical history.  To be honest, I’ve been surprised by how many of them actually do have the proper records.  However, it would be much more helpful if any of the writing in them was legible and physicians weren’t trying to cram years of medical visits onto what is essentially a notecard.

I don’t mean to put a totally negative spin on Manguzi medicine.  It has definitely been a learning experience, but mostly not an unpleasant one.  Every day, I am amazed by what we are actually able to accomplish with such limited resources.  The majority of patients here do quite well.  It’s remarkable to watch how dramatically a patient can turn around once they are receiving proper treatment for their conditions.  One child on the pediatrics ward was too weak to even sit up on his own last week and today he came toddling over to me carrying his bowl of porridge to share. (I passed on that offer J).  Another mother told me that today was the first time in months that her child had laughed.   Those are the moments that help me get by on a day like today. I have to remind myself that, if it weren’t for rural hospitals like this, most of those children would not survive.  Though the patients you cannot save definitely stand out far more, they are, fortunately, the rarity.  Practicing medicine in Africa definitely requires looking at the “big picture.”

Another nice thing that comes with such an underserved and understaffed hospital is the chance to have far more autonomy than we would ever be allowed at home.  It turns out that, with my several electives in inpatient pediatrics this year, I actually have more pediatric experience than many of the doctors here.  At home, it is very unusual for a resident or attending to ask a student for their advice or opinion.  Here, it happens all the time.  There is much more of a feeling of teamwork amongst the physician staff than at any other hospital I’ve worked at.  Everyone’s strengths are well known, and no one hesitates to ask when they know someone else has more experience or knowledge of a topic.  Even within the four of us medical students, we each have our own areas of interest and frequently run ideas by each other before we treat our patients. The low number of staff also means we get to do a lot of procedures.  I did my first successful spinal tap today and Bryan did several (he’s much better at them than I am).  I’m also getting lots of practice at putting in IV lines, suturing, and administering various medications.  In terms of experience and education, I don’t think we could have picked a better place to spend a month.  And though it’s not been easy, I think we have all found that we have the strength to face much more than we expected.

To end on a happy note, we had a German dinner gathering last night.  Our friend Jonas (who is from Germany) cooked schpaetzl for about 25 people.  That is A LOT of schpaetzl.  For those of you with a lack of knowledge of German food (like me), it is essentially a macaroni and cheese with homemade noodles and caramelized onions.  And it’s delicious!  I foolishly offered to help cook which was fun, but when you are cooking for that many, using all four burners and the oven, it gets miserably hot in an un-airconditioned kitchen.  We served it up at our place and sat out by the pool to eat it.  It was a really fun evening.  Tomorrow, we are going to nearby Kozi Bay which is along the Indian Ocean.  They have hiking and snorkeling, and we are going to have a braii (barbeque) on the beach before we head home. We are off to Mozambique on Friday for the weekend, but hopefully I will have a chance to do another post before then.

Hope everyone is well. I promise the next post will be much cheerier and have a few pictures as well. Miss you all!

Animal Kingdom

What a wonderful weekend we had! It gave a whole new meaning to the phrase “animal kingdom.” Other than deer, raccoons, armadillos, and the occasional buffalo, I have not seen many animals in their natural habitats.  Although I have always enjoyed seeing wild animals at the zoo, it’s hard for a creature to appear impressive when it has only a small enclosure to roam in. When I saw my first wild elephant this weekend (from a distance of less than ten feet!!), the only word I could think of was “majestic”.  It was almost surreal.  When you are the one enclosed (in a jeep) and the animals are free to roam in their natural environment, they suddenly appear infinitely more gigantic, beautiful, and in charge.  I could have watched each one for hours! If all animals together make-up a kingdom, then these African beasts are certainly the royalty! But I guess I should back up a bit and tell you about the weekend.

We headed out Friday afternoon for the short drive to Tembe Elephant Park.  On arrival, we were greeted by a group of singing Zulu women who handed us lavender scented towels.  We had no idea we were staying at such a posh place! Come to think of it, I don’t think I knew posh and safari could be used in the same sentence until now. We then had about an hour to get settled in our tent before dinner.  Now, before you question the “posh-ness” of a tent, let me describe it.  The whole tent was on a platform raised about 3 feet above the ground.  It had electricity, running water, comfortable beds, and a giant fan.  Here’s a picture for you which is probably better than my rambling description.

Wish we could take this to Manguzi with us

Dinner was quite impressive. (You’ll have to excuse my frequent use of the word “quite”.  It’s all these darn British people I’m surrounded by.)  They hired a chef from Durban and he is an extremely good and creative cook.  We had a peanut chicken salad appetizer, chicken and vegetables for a main course, and incredibly delicious bananas and caramel over ice cream for dessert.  Bananas at home don’t quite hold a candle to the ones here. Then we drank wine by the fire and chatted with some of the other guests for a bit before retiring early.

Morning came early with a 5:30 wake up, but it was nice to sleep without any roosters, barking dogs, or midnight bulldozer interruptions.  They fed us a quick breakfast (the first of three!!!) and we were off on our first safari ride.  Our guide, Voozie, is a member of the Tembe Tribe (a division of the Zulus) and he was extremely knowledgeable about the park and all its animals.  The first part of the morning drive was a bit dull.  It was cold and rainy. We didn’t see much and I actually started to fall asleep. We did stop at the watering hole hide where some rhinos and various deer-like animals were drinking.  But they were awfully far away, so it was hard to get too excited about it.  We stopped for a quick breakfast #2 of tea and rusks (which are similar to scones).  Shortly after that, the sky cleared up a bit and the animals came out from wherever they were hiding.



The watering hole with two rhinos



The first thing we saw was a giraffe (which we are going to refer to as a long-necked leopard so we can say we saw all of the big five).  They are soooo tall! A bit later, we turned a corner to find an elephant’s large butt had come into view.  He was walking down the trail in front of us.  He moved over and we pulled up alongside him.  Being less than ten feet from an elephant sure makes your heart be fast.  He was very peaceful, just chewing away at some leaves, but his tusks looked awfully sharp.

We returned from our morning ride to find breakfast number three being served.  Apparently this was the full breakfast. After being sufficiently stuffed, we attempted to take a nap.  Unfortunately, there is ZERO breeze in Tembe and about 20 minutes after drifting off, we all woke up drenched in sweat.  So we migrated to lay by the pool instead.  Funny side note…on our initial waiver that we had to sign, it notified us that the water was electrified at night to keep the elephants from drinking it.  Knowing how few people actually read those forms, I can’t help but wonder if anyone has ever had a rather shocking (literally) midnight swim.



The Other Big Five :)



After lunch, we went back out for the evening drive.  Not long in, we saw an elephant who was dripping wet and figured there must be a watering hole nearby.  There was, and standing in it were three huge cape buffalo.  They are some of the ugliest, most threatening creatures I have ever seen.  They wandered off quickly leaving seemingly only some birds behind.  However, our guide’s well-trained eye spotted three lions asleep under a tree about 100 yards off.  It wasn’t long before a lonely little nyala (basically a very small deer) wandered onto the scene.  The lions were awake instantly and two more emerged from the hills.  They watched without moving for several minutes while the little guy drank and then, as if a silent alarm had sounded, the three females leapt up at exactly the same moment and took off after him.  They must not have been very hungry because they gave up quickly when the nyala disappeared into the woods.  A bit later, a family of zebras came by, including a baby.  When the zebra in front noticed the lions, it stopped.  For the next five minutes, not a single animal moved.  It was really strange, the lions and the zebra seemed to be having a stand off. Then, in the blink of an eye, the zebra whipped around, corralling the others, and took off.  The lions gave a half-hearted chase but again return quickly to the shade of their tree.  The guide said it is pretty rare to get to see a lion go after anything.



The zebra vs. lion stand-off (3 lions crouching in front of bush)



The rest of the ride was uneventful with the exception of a beautiful sunset.  Back at the camp, we had another delicious dinner, this time with poached pears soaked in orange and cinnamon for dessert.  Yum! I actually ate two of them, which I justified by my primary source of calories this week being PBJ sandwiches. Bedtime was early again so we could get up for our morning ride.  Nothing terribly exciting to report from that ride, but we did see some cape buffalo from about eight feet away.  It was the only time I saw Voozie look slightly nervous.  They actually came into our path and stood facing us, like they were daring us to pass.  I was relieved we didn’t try.  Eventually they got bored and left.



Sunset in Africa



Cape Buffalo (they look like German barmaids)



After one last breakfast, we packed up and headed back to Manguzi.  We never saw a leopard, but I guess they are actually quite rare.  One other guest said she went on safaris for 15 years before she saw one.  I guess four out of five isn’t bad for my first safari.  Plus, I got to see a giraffe and a zebra, which I think got the shaft by not being included.  Our guide told us there is also an Ugly 7 which includes the warthog.  I have to agree…they are quite unfortunate looking. Overall, it was a really amazing weekend.  I took lots more spectacular photos, but these will have to suffice for now. Now it’s back to work until next weekend.  I’ll write again soon.  Miss you all!

Oh, and here’s the picture I promised of the car pushing fiasco. J Enjoy!