Halloween Hot Dog

So, as I mentioned previously, I really wanted to try and come up with a good Halloween costume this year. My goal was to out do, or at least come close to the shower costume I put together last year (I really need to get some pictures of that costume online, but dont have any in Africa). Anyway, just as we were drifting off to sleep, Kylie blurts out "We could be a hot dog! You'll be the dog and I'll be the bun!" We laughed at first, but then I knew that was it. We started to talk about how we might put it together. We'd need lots of fabric, color would be key. We'd need that pillow stuffing stuff to stuff it with stuff (stuff, now typed 5 times in one sentence). This would have been difficult in the States, but we were in South Africa where we couldnt exactly head down to Hobby Lobby and pick up what we needed. We really had no idea how to do this.

Kylie tried to sway us from the idea. She said it was too much work, and well, she was right, it was way too much work. But I thought it was too great to pass up. We found a great wholesale materials store on Thursday, and made our first step towards a hot dog Halloween.

Kylie was truly brilliant in the cloth store. She pieced the idea together in her head. I gave my advice and opinion, but she was the mastermind behind most of it. The hardest part was going to be the bun. We needed the right color fabric and it had to be shaped like a bun. For some reason, I kept suggesting that we go with yellow for the bun color. I still dont know what I was thinking.

Now I did come up with the idea for the weener part. They made this rolled up foam material and I wrapped myself in it in the store. I picked out the red felt material, and decided that we'd also need some arm holes.

We had the raw materials purchased. There was no turning back now. It was time to sew.

And sew we did. I worked on my dog while she worked on the much more complicated bun. We cut and sewed and arranged these materials for hours. Friday evening, when we were nowhere near done, we realized how much time this project was going to take. But we couldnt turn back now. We had already invested hours of time and a lot of Rand.

Saturday, we watched the equivalent of 5 movies in the background while we worked. It essentially took all day. We had to HAND SEW EVERYTHING! My weiner suit is acutually two large rectangles of fabric sewn together with the foam stuffing material in between. Kylie ingeniously cut and designed the mustard strip, which I think is by far the best part.

We finished the costumes around 8 pm Saturday night. Nupe and Anand came over for drinks before hand (which meant LOTS of very rapid clean up) and we relaxed at our apartment for an hour before we left. The group of largely American kids thought the costume was great. So we decided to try it on a gang of drunk South Africans.

We went to a big house party at the communal residence of some university students. We didnt know many people when I arrived, but I think lots of them now know us. We got lots of wierd looks before people realized what we were. But once they caught on, it was a hit. Kylie especially looked odd standing alone without her dog at her side. People thought she was either an eclair or a butterfly.

Much like my shower costume last year, members of the opposite sex seem to flock toward costumes that allow for covert party kissing. Kylie's bun costume could easily close in around someone and this seemed to entice a few South African guys who fluttered towards her like bees to an orchid. They really seemed to want to get between her buns, so to speak. Luckly I was there to fight them off with my felt-lined hardhat and defended my position as Kylie's number one weenie.

We wore the costumes for most of the night. It wasnt much fun to stand the whole time, but we got used to it. We even danced a while, and just generally had a good time. We finally made it home that evening, exhausted and with very sore backs from all the hours of bent over sewing.

It ended up being a major endeavor to put all this together. We wondered if we would have gone through with it all had we known in advance how much work it would turn out to be. But as awful as it was to stich the whole thing by hand, it made for a great night and a costume that I felt was on par with years past.

We arent sure what to do with this oversized hot dog in our apartment now. We certainly dont want to throw it away. Perhaps we could sell it to a costume shop. But for now, it makes an out of place addition to our apartment decor.

HAPPY HALLOWEEN

Where in the world?

Some friends and I are planning a trip in the spring. Two other Fogarty fellows (Craig in Mali, Paul in Tanzania, and perhaps Blake in Kentcucky?) and I have been discussing via email where we might like to travel. Most likely someplace within Africa, but not opposed to some place a little more remote (excluding Europe, of course). Here are our choices so far. There is not much I can say about each one, because I specifically selected countries I have not been to and know very little about.

• Senegal: very safe, chill place from what I hear. My only glimpses of Senegal come from Dave Eggars book You Shall KnowOur Velocity and from a documentary where Trey Anastasio and Dave Matthews cruise around the country looking for people to beat up. No, wait, I meant people to play music with, those two guys couldnt fight their way out of a paper sack. But anyway, YSKOV was a good book, a Dave and Trey made good documentary (or rockumentary, if you will) so, I imagine Senegal has to be a cool place, right?
• The Gambia: A tiny sliver inside Senegal that follows the Gambia river. This place sounds and seems fascinating. Its literally a country whose borders are based along a river. They must like totally LOVE that river so much that they mapped and named their country after it. I would love to go see what that is all about. I wonder if I would contract schistosomiasis if I were to float this river in an innertube. Entirely likely, but perhaps worth it.
• Ethiopia: I think most people my age hear Ethiopia and imagine starving children. At least that was the first thing that came to my mind for most of my life. But I am old enough now to know that there is much more to this country. They are the only African nation that was not colonized (except for a little spat with Italy in WWII). I know very little about what there is to do in Ethiopia, but I bet there arent very many tourists, and that is a plus for me.
• Djibouti: This small country borders Ethiopia, Eritrea, and Somalia. I know very little about this place as well, except that it has a cool name. If we go, I hope to make t-shirts that say "Spring Break Djibouti 2006!!!"
• Mauritius: This is a beautiful French island off the coast of, well, nothing. Its kind of out in the Indian Ocean all by itself. Its still considered Africa, but it is really influenced more by France and India. Would be more of a beach type destination than a real cultural experience, not that there is anything wrong with that. I bet the surfing would be excellent.
• Jan Meyen: I cant belive this place is even a country. Are there even people there?

God bless the CIA World Factbook. I am so glad we have spies all over the globe gathering information on these countries. They must work so hard. How else would we know that the highest point in Azerbaijan is Bazarduzu Dagi at a whopping 4,485 m if we didnt have CIA operatives stationed there, constantly updating us on the latest developments. Curse Rove and Bush for compormising the identities of CIA agents when they bring us things as wonderful as the factbook. Oh, and curse them for being narrow minded fools as well.

Ok, I am getting off track here.

I will now ask for input from the audience. Between 20 and 100 people vist this site a day, but very few comments are left. I would like to ask for people's inupt on this. Am open to other nearbye countries and arctic research stations beyond those listed here. Would like to hear your input. Leave comments below!

Big Man

This is crazy. Its a statue of on obviously large man at a museum in Paris. Its appropriately entitiled "Big Man"The exhibit is called 'Melancholy-Genius and Insanity in the Western World' at the Grand Palais in Paris.

FYI, my yahoo homepage selects the most emailed picutres every few days. Usually they are pictures of Brazilian volleyball players in their swimsuits or maybe a shot of a 200 lb catfish someone caught in Missouri. But sometimes, they are interesting, if even odd, like this one.

I just realized I am missing college football...

This should be apparent to me by now as it is several weeks into the season, and I obviously knew about this already. But college football is one of the few sports I actually enjoy watching on TV, and I am missing it. All I hear about is rugby (which I dont mind at all) and cricket (which I dont understand at all.

The absence of college football in my life was made particularly known today when I saw on ESPN.com that Texas had come from a 28 point deficit to defeat OSU (story here). I certainly miss certain things (other than people) while I am away. Watching college football on Saturday is certainly one of them.

Note: the actual chances that I would have watched this game had I been in the states: 18%. But man it would have been a good one.

This is awesome

Pretty cool thing for G-town. Wish I could be there.

The wall of Zulu

I dont think I have ever lived amidst a more confusing culture than that of the Zulus. I suppose confusing is a bad word. I think its more likely my inability to understand than the inherent complexity of their way of life. There are countless times when I am trying to explain something, trying to make a joke or a reference, and get blank stares in return. It happens with patients, who are often uneducated, but it also occurs when I try to converse with nurses or HIV counsellors. Maybe I am just not as funny as I had previously thought.

I remember feeling the same way with Brent when we were last here. In fact, the immense cultural and language barriers we encountered here were one of the many arguments for us to move our project to Latin America. The language was learnable, the culture more like our own (but still pretty different).

Its a really profound thing to encounter in life. When someone's way of life is so different from yours, you really have no way of understanding where they are coming from. I remember participating in a Zulu ceremony in 2001 that innvolved the slaughter of a goat and a day long ceremony that followed the next day. Once it was over, I was the proud owner of a new goat skin bracelet (it was still a little wet). People kept saying how happy they were for me, especially how happy they were for my family, my mom and dad. I just couldnt understand what they meant, but it was repeated to me often. It was the first time I realized how a little I really understood about the world.

Kylie is finishing the Poisonwood Bible, and I have been reading over her shoulder some of the time. Its about a missionary family who tragically find themselves in the middle of the Belgian Congo right around the time it fell apart. But they touch on this idea often, on how immense cultural barriers can be. It can be difficult to navigate, especially if you hope to work and make a difference in a foreign community.

Halloween Costume

I thought that by coming to South Africa, I would be off the hook as far as trying to think up a creative, outlandish Halloween costume. I have had some decent costumes in the past, beginning with dressing up as Dr. Smith, our elderly pathology professor my first year of medical school (only funny to UTMB folks, sorry). Second year I was painted head to toe In multicolor latex body paint (thanks to Pooja and MD) and went as dermatome man. Last year, I spent hours in my garage putting together a Daniel-son Karate Kid shower costume. Complete with real looking water and a shower curtain.

How could I possibly out do the shower costume?

So this year, I figured would be a vacation from Halloween. Its not big here, so I wouldnt have to outdo my previous year's costumes. Then Kylie talked up all of my endeavors to a group of friends, and they asked what I would be wearing to the Halloween party this Saturday. I am kind of an all or nothing type of guy (for better or for worse...) so if I was going to do Halloween, I planned on doing it right. No cheap rent-a-costume of a monk or devil.

Kylie and I wracked our brains for something to be. It had to top the shower, and it had to happen fast. We talked and thought, and avoided the issue, came back to it, and thought some more. Then, just as we were falling asleep, Kylie came up with the idea. It was so brilliant, she didnt even realize it. She immediately dissmissed it as a joke, but I believed wholeheartedly that it was my only hope of topping last year. There was no turning back now.

So I am not going to tell you exactly what the costume is. Its still in the works, and there is a lot of work to do before Saturday night. Chances are, most South Africans will be terribly confused, and wonder who and what the hell we are. I will share the hint that its a two person costume, and that if I back out at the last minute, I will be a real weenie.

We'll take lots of pictures of ourselves and of confused South Africans. Its going to be great.

Crazy World

There is a lot going on in the world right now. Not all of it is good, in fact, most of its bad. But it all seems important. I wrote a lot about Hurricane Katrina and Rita, but have ignored some major events as of late. Well, I just havent written about them. Really, I havent written about much to be honest. More work and less internet access has caused this. Should change again on November 1st when our internet comes back online at home. Anyway, here is a list of what I think is important in our big mundo right now:

• Bush's supreme court nominee withdrew herself from the running to serve on the highest court in the nation. I thought Bush was trying to sneak in a pro-lifer hidden in the shape of a moderate seeming woman. But since she never outright said stated her stance on abortion, I think she lacked conservative support. Big blow to Bush's already weakening second term.
• Tragic earthquake along the Pakistan-Indian border that killed over 20,000. Why do natural disasters have to hit the poorest, most remote places on the planet? The UN is demanding worldwide support with a real sense of urgency. I think they are genuinely worried that if aid does not reach some of the remote villages before the snow covers the Himalayas, that even more deaths will result.
• Bird Flu. I doubt this is news to anyone. Its on the new every day here. As I understand it, there is a deadly form of influenza virus that has undergone genetic shift (or is it drift, help me out here medical students). Its highly virulent right now, having killed lots of birds and a few humans. But as it is, the H5N1 is not that contagious between humans. I think the concern is that it may mutate again, and gain a combination of virulence and contagiousness (is that a word). There hasnt been a major flu pandemic in many years, and they occur pretty regularly. This scares me, but only a little right now.
• The president of Iran made outrageous claims that it would like to wipe Israel off the map. This is some pretty disturbing news, especially considering their nuclear ambitions. I also see this as such a threat to US-Brittish security, that invading Iran doesnt seem like a very distant possibility. You know they want to do it, now the dumbass Iranian president is just giving them more and more reason to do so.
• Wilma was the most powerful recorded hurricane in the Atlantic, EVER, recording a record low 888 mb. Fortunately it weakened considerably and didnt do too terribly much damage to Florida. Sadly, mudslides from Wilma burried hundreds in villages near where I used to live and work in Guatemala.
• I watche the House of Sand and Fog last night. Man, that is a good movie. Quite intense, dramatic, and tragic. But extremely well done.
• The Astros made it to the World Series for the first time in many years. But they got wiped out by the White Sox 4-0. Sad, because the White Sox are such a lame team. I mean, who even likes them?
• FINALLY, the biggest news of the week: I am coming home for Christmas. Yes, mark your calendars, I will be home for about 3 weeks starting December 21. I plan to have lots of African presents for everyone. Cant wait to see friends and family and may even make a trip to Galveston if anyone else will be around.

So except for the personal accounts, I really have no idea if all the above information is accurate. I just wrote all that from memory, so feel free to correct me if I am spreading misinformation. But CNN is pretty much the only channel we have worth watching, so I see the same stories over and over again.

Mali

Today I must refer you to my friend Craig Connard's weblog. He is one of the other Fogarty fellows in Mali. He just put up some really interesting posts about Ramadan (which unbenkownst to most of America is going on right now) and about one of his patients with cerebral malaria. Yes, he is goofy, and yes he often refers to himself in the 3rd person, but he wrote some really amazing stuff. I tried to only skim it last night, but ended up reading about every new word he had posted. I felt I could relate in some ways, but in others I could only imagine what these experiences must have been like. Sad, fasinating, and often funny stuff.

PS - did you know that Mali is one of the poorest countries in the world and is almost twice the size of Texas.

My project

So, at this point, you might be wondering: "What does Cully do with his time in South Africa besides surf, chase elephants, and update his blog?"

And you would be write to do so, since that is all you hear about. I intentionally leave a lot of what goes on at work out of my weblog as its often pretty boring to just about every one but me, and I even get pretty bored with it at times. But I cant have everyone thinking I just lay around and sun myself all day (although, thats all I really did yesterday), so here is a description of what I am working on.

I would say that my main role is that of a "Study Clinician." I essentially work as a primary care doctor for patients with HIV that are on a regimen of antiretroviral drugs. I do this at a rural clinic once a week, and at the Durban clinic 2-3 times a week. I see patients at various stages of treatment. Some are very ill and have very low CD4 counts. Others were sick previously, and are now doing much better. Still others no longer have symptoms related to HIV or AIDS, but suffer from the many side effects of the powerful drugs they are taking. Regardless, its easy to see what good these drugs can do in a patient. They gain their lost weight back, their skin is no longer chronically infected, they dont suffer from oral fungal infections, and generally they just feel better. This is really rewarding to see, and I feel priveliged to be a part of it all.

The not so exciting part of my work is the research. I am currently collecting data on all the patients who have CD4 counts below 50. Normal is around a thousand and they say you are diagnosed with AIDS at 200. So these patients are particularly ill. We have all their old charts, but have to transcribe them into a database that automatically checks for errors and contradictoins. This is the really boring part. We take physicians notes, and fill out lots and lots of paperwork. Its not a lot of fun. But in the end, all our data will be in this great database that can be manipulated by statisticians and drawn up into charts, graphs, regressions, etc. The end product will be a paper that describes a cohort of 100 patients with very low CD4 counts, 50 of whom are on antiretroviral treatment, 50 of which are not.

I am also hoping to use this data and this paper for an honor's thesis at UTMB. Its a lot of work to put together, but I am basically doing the work already, so I might as well try and get some credit it for it all.

Well, that is about it. I will likely not report on this stuff too much. I will certainly mention patients and interesting people that come up, but I dont think too many people are dying to hear how the data transcription is coming along. So if you want to know more, just ask.

The Secret Spot

Kylie and I drove about 30 minutes outside of town to a small Surf Camp/Hostel/Backpacker type place. We almost decided not to go at the last minute, as we had no idea what to expect. But we gambled, and pulled into the Secret Spot on Friday evening.

It was well worth the trip. We found a clean, recently opened hostel with a very friendly surf-knowledgable staff. They knew all the best places to surf in the area and even woke up early Satuday morning to show us the way to the beach.

We surfed at Salt Rock beach. Unlike beaches in Durban this was a very safe, relaxed, friendly environment. There werent 10 people trying to catch the same wave, just a group of friendly longboarders out surfing at dawn. Here, we even felt safe leaving our stuff setting on the beach! This would be unheard of in Durban, where you are always nervous about someone trying to steal your wallet, your board, or you car.

We had a great weekend surfing, reading, relaxing and getting sunburned. Ready for another week of grueling work at the clinic...

Our Dirty White Car

I wrote this a few days ago:

We were down at South Beach today unloading our surfboards when a man came up to us asking if he could wash our car. He was a short, black man dressed in some dirty pants and an old soccer jersey. He kind of wandered around the car as we pulled on our wetsuits. He kept saying to Kylie, “Meessess, please, ten rand for a wash, please, I wash your car very good.” I could tell Kylie was uncomfortable. He didn’t necessarily appear drunk, but he wandered a little too closely into our comfort zone.

We were immediately suspicious. People come up to try and sell us things all the time, but this guy seemed to linger longer after we said no. Also, it was very early and there weren’t many other people around, so we were a little more concerned than usual. He continued to plead for 10 rand to wash the car, and we continued to refuse. We locked the car, and walked down to the beach. He seemed angry and disgusted with us.

As I surfed, I thought a lot about the situation. You are warned repeatedly about crime in South Africa. You hear about elaborate ploys that people use to steal your car, your bank card, your cell phone. You are taught not to trust anyone. These warnings made me wonder if this offer to wash our car was really just an excuse to stay close to it long enough to open it up and steal what was inside. Our car was dirty, and we had 10 Rand in the ash tray (about $1.50). But I thought we made the safe decision.

When we came back, we saw the guys washing another car for 10 Rand. They didnt look like they were going to steal it, just trying to make it cleaner for the owner. I realized that what had just happened was part of a cycle. Wealthy white people are worried and suspicious because of all the crime in South Africa. So when someone comes up to offer us a car wash, a broom, a necklace, or anything they can sell to make some money, we refuse. I though about how unreasonable we must have seemed to them. He had a right to seem angry. Two white people, obviously wealthy enough to have surfboards, refusing a car wash for what amounts to the change in our ash tray. 10 Rand is nothing, and we needed a car wash, yet we refuse out of fear. So we force a guy trying to make honest money to perhaps turn to crime. He steals someone’s purse or wallet. He contributes to the generalized fear of blacks in South Africa, the rumors circulate, we all warn ourselves into a state of paranoia, and the cycle continues. This obviously was a small example, but this happens everyday, all over South Africa.

So I have made this observation, but I don’t know how to break the cycle. I worry that letting your guard down really will result in theft of your car or your wallet. But that guard seems to keep blacks poor, and whites safely behind electric fences. I see why things like affirmative action get put into place, and that certainly is prevalent here. Some way to break the cycle

Well, its late and I am too tired to think of a solution to the racial tension that has been brewing in South Africa for hundreds of years. I just thought I would share this one example that might explain why it still exists today.

So, I have been a little busy for the blog lately. Sorry about that. We've had some problems with internet at home, and it wont be back until November 1st. Thus, I can only really post at work, when I should be working. So I totally am just resting on my laurels and just post a few cool pictures from weeks past.

This was one of the strangest orchids we saw in the Orchid House at the gotanic gardens.

Close up of a flower from the Durban Botanic Gardens.

Zulu maidens carrying their reeds to the king.

Aspiring Zulu warriors.

One of the Umfolozi guides bet me that I couldnt make a fire with just one match. I proved him wrong and only lost consciousness 3 times from blowing into the fire so hard.

This really pisses me off....

Mugabe at the UN Food Summit (which is tragically ironic to begin with) using this platform to criticize Bush and Blair. Now I dont like Bush and I dont think we should be in Iraq, but this makes me despise Mugabe even more than I already had.

This is a guy who allowed rebels to "reclaim" land from white farmers in his country, usually by violent means. As a result, his country is starving to death, and in utter economic ruin. He is an evil corrupt man, and its sad that the UN even let him in the door to the food summit.

I read once that if you stopped corruption in Africa for one year, the money that would be saved could feed the entire country for that same year. I truly hate leaders like this. They are impediments to human decvelopment, to human dignity, and to the well being of of all Africans.

Bad thing about living in South Africa #2

The radio is truly, truly awful.

When we dont have the trusty iPod to plug into the car stereo, we are forced to either listen to the sounds of traffic, or to the Durban radio stations. Its a toss up as to which we prefer.

When I say radio, I really mean the music. The DJ's are actually relatively entertaining. They seem like personable people with a decent sense of humor. That is what makes it so shocking when they play some of the worst music ever produced. Let me give you a quick example of some of the things they play.

• Lots and lots of terrible pop hits like Brittainy Spears, Christina Aguilara, Backstreen Boys, etc. Not only do the play this stuff regulalry, they talk about it like its GOOD MUSIC. As if Brittany is some pioneer in music. They were all pretty pumped about the new Lindsey Lohan song.
• They play old 80's music, but its not even good 80's music. For example, old Wham (the George Micheal band). But they play songs by Wham that I dont think were popular in 1984.
• Terrible, terrible dance music. Our current favorite is a dance song that simply repeats "Today is the first day of the rest of your life"over and over again. I mean, seriously, who sets overused cliche's to a thumping base rythm.
• Lots and lots of Micheal Bolton. I am reminded of Bob Slydell from Office Space saying "I celebrate his entire collection!" I wouldnt put this comment past those DJ's, they seem to love the Bolt-man.
• There is an amazingly annoying trend in pop music here innvolving the use of Alvin and the Chipmunk's sounding voices in the background of songs. One is called "So Lonely" by some guy called Akon. Its terrible and all of South Africa seems to love it. I have noticed the Chipmunks singing back up trend occurring in awful pop songs. Much like the Cher voice wobble that infected bad radio songs in the 90's.

So, I am obviously exagerating and being particularly hard on them, but its something I have noticed here. Promise to write something positive next.

Lucky Lightening Shot

I have always wanted to take a good picture of lightning. I remember spending hours on Lago Atitlan with Chad and David trying to capture cloud to cloud lightning with our cameras. We never caught any bolts, and the images failed to capture what an amazing storm we were getting to see.

I took this picture in Umfolozi game park last weekend. The second night, a large thunderstorm came through and I swapped my digital camera out for my (mom's) 35 mm Nikon (thanks again Mom). The lightning display was truly amazing. Huge bolts of cloud-to-ground lightning all around us barely preceeding deafening cracks of thunder. Yet, not a drop of rain at this point. I set my shutter speed to 8 seconds and maximally opened the aperture. I had to sit and hold my camera steady on my knee while the shutter was open, and a few of the pictures came out blurry as a result (I need a tripod!). But during one of the shots, a huge bolt struck right in front of me and the thunder clapped right behind it (suggesting that it was pretty close to us). I saw the bolt for a few seconds after it had dissapeared, somehow still imprinted on my awe-struck retinas. Thus, I thought this particular shot might come out well. The other 10 shots I took were kind of ruined by cloud to cloud lightening that drowned out the stark contrast of the bright whtie bolt against the dark black sky. This one was just lucky I guess.

I developed the pictures Saturday, and had the photo store make me a CD of the images so I could post them. I cropped the picture a little, so the bolt looked a little middle. This .jpg makes a great desktop background as its black all the way around the edges, so email me if you would like a full size copy for your computer. Would be happy to share.

Hackey Sac, Spades, & Poets

Had a great weekend. Hung out with Anand and Nupe Friday night. Played spades, drank some beers, talked. Its getting nearly impossible for us to get together and not talk about HIV in South Africa. This is not a problem or anything, just something I have noticed. Its just a topic that is on our minds quite a bit, and we all have varying opinions about. Regardless, they are good guys and I am glad we have run into them.

Spent most of Saturday playing hackey sac with Kylie at the Botanic Gardens. I am not sure how this happened, I kicked a hackey sac in years. But it was a nice day and there was a beautiful open green place to play. Kind of dorky, but very fun.

Went to a great poetry reading Saturday night at the BAT Center. Poets from all over the world. The best was an American girl who sounded as much like a rapper as a poet. She had a mic, and some sample pedals. She would spout a beat into the mic, capture it, and play it on repeat and then freestyle rap to it. It was pretty impressive. She read a poem about Durban, about how we are all human and have human needs and desires, regardless of our skin color. There were Cuban poets who read in Spanish, Iraqi poets who read in Arabic, and lots and lots of freestyle rapping. It was well worth the $2.50 entrance fee.

The Moose

Went on ward rounds with Dr. Moosa today in King Edward Hospital. Dr. Moosa is the authority on clinical management of HIV/AIDS in Durban. He did an infectious disease fellowship in the states and even has a PhD in microbiology. Knowing this, I imagined him as a crochity, old professor who was so high on himself that he couldnt see down to his patients. But Dr. Moosa was quite the opposite. He was young, energetic, friendly, and powerfully dedicated to his patients well being.

 

King Edward Hospital is the large facility where the University of KwaZulu Natal's medical school does their training. Its a massive, completely rundown complex of old decaying buildings. Absolutely nothing like a hospital in the states. All the beds were in one room, the floors were filthy, and patient's charts were messy piles of soggy papers. Still, it was much better than hospitals I have seen in other parts of Africa.

 

I find hospital medicine in America to be quite confusing and overwhelming. Even if you are able to master the clinical knowledge to diagnose and manage a patient, inumerable impediments seem to keep patients ill and in the hospital. Lab tests take too long, X-ray machines are unavailable, you need a dermatology consult, but they cant see your patient until next November. Pushing a patient through the hospital system is separate skill one must master in addition to the massive amount of clinical information.

 

So imagine all those logistical problems I have run into in the states, and multiply them times 1,000. That is what Dr. Moosa faced with his patients everyday. Cetainly, his patients tremendously confusing in their clinical presentation. Almost everyone had HIV and TB. They almost all had liver problems, but it was often impossible to tell if the liver problems were a result of the TB/HIV medicines, their possible hepatitis, or perhaps TB of the liver. But even if he knew exactly what was going on and what to do (which was rare, even for a very bright guy like Dr. Moosa) it seemed impossible to navigate the disorganizational nightmare of King Edward Hospital. Nurses never did what they were told, labs took days to get results, patients couldnt afford their medications, and the list goes on. To me, it seemed like an impossible and terribly frustrating place to work.

 

Yet, Dr. Moosa plunged through all this. Sure, he got discouraged when the nurse failed to write down how much fluid a severely dehydrated patient had recieved, but he never gave up. He flew from patient to patient, told them to hang on, that they were going to get better. He grabbed nurses, and made them put in NG tubes right then and there, for fear that his requests would not be answered otherwise. He showed incredible determination, and seemed to have mastered both the clinical and logistical complexities of the hospital.

 

But to me, it still seemed like some abstract nightmare. Dr. Moosa himself said that he acted on instinct much of the time, that he rarely knew exactly what to do. I dont operate well in situations like this. Things need to be clear, tangible, and easy to see. I felt the same frustration in my internal medicine rotations. It just all seemed so gray, when I wanted it to be black and white.

 

Right now, all this contributes to the notion that I should go into surgery (if you can understand that mental leap, I am not sure that I even do). I really do wish that I loved internal medicine and infectious disease. I wish I could do what Dr. Moosa does, and enjoy it. But aside from the fact that I dont think I would be very good at it, I dont know that I would enjoy it. Its a shame, because I think the world needs more medicine doctors who can treat HIV patients. But as fickle and indecisive as I am, who knows where I will end up.

 

Regardless, I am glad there are people like Dr. Moosa out there who still really do care about their patients and work through all that mess to make them better.

Clarification

Kylie has brought it to my attention that my posts about surfing may suggest that I am actually a good surfer. Please allow me to clarify that this is certainly not the case. I am not good, at all. Really, if any of you were to see me in the water trying to catch waves next to some of the most amazing surfers around (many of whom are half my age), you would certainly laugh. I am routinely and thouroughly humbled when I head out everymorning. Yet, I do appreciate the locals not laughing at me when I eat it on a big wave (though I am sure they do while I am underwater for a very, very long time). Just wanted to make sure you all understand this.

Umfolozi Elephants

We arrived for our weekend hike in the Umfolozi Game park on Friday October 9th. South Africa has several parks just like this one. They are vast, fenced in areas where wild game are kept. So while they are inside a fence, the animals roam and live as they please. Lions kill the antelope, rhinos take massive rhino-poo's everywhere. No real intervention is made to save the sick or the injured. Its very similar to the way the wild country was 200 years ago, just inside a fence and more concentrated. Typically, you are allowed to drive through, but are advised not to get out of your car as many of the animals are quite dangerous.

Speaking of which, which of the following would YOU predict to be the most dangerous. i.e. which would you want to avoid the most on a trail: lion, jaguar, rhino, elephant, hyena, water buffalo, giraffe, zebra. Think of an answer now. Ok, keep it in mind as you read.

So we first met our guide for the weekend. His name was Bheki (which sounded like Baggy when he said it). He was a tall, dark South African and toted a huge .458 rifle with him on the trail. He was really great the entire hike. Very personable, informative, and most importantly, was very careful when it came to protecting us from dangerous wildlife.

He gave us intstructions on what to do in the event that we would come across various animals. Pretty much, the rule was do what he said and he would use his gun if need be. I was just happy he was a dude, as I was on the trail with 7 other females at this point.

We hadnt walked more than a few hours to our camp for the evening when, Richard, the back up guide spotted a large male elephant strolling down the trail towards us. Suddenly, there was panic.

"Follow Richard, go, now! Everyone up de hill!" cried Bheki. We did as we were told, still kind of excited at the thought of evading an elephant. We quickly scampered up a rocky hill. Bheki came up a little later, and invited us all down for a closer look. We walked down the hill quietly and slowly. We took a few pictures of the huge animal grazing on the tree branches. I was the furthest down the hill, the closest to the bull behind Bheki. Seemed safe.

Then, out of nowhere, the elephant began to walk quickly towards us. Bhekki yelled for us to run up the hill. There was even more urgency in his voice this time. Then the elephant lifted his head, began running full speed toward us, and made loud elephant noises. He was mad, and was charging at us. I quickly turned and began to sprint up the hill. However, I was immediately stopped by a wall of girl's backpacks. "Oh, this is wonderful" I thought, "I am going to get trampled because these girls are too slow." I thought for a moment about side-stepping them, and relying on my male athleticism to get me out of harm's way, but then I realized that that might not be very gentlemenly. So I waited for the girls to run up the hill, and I followed behind as the elephant approached. Bheki remained behind me, rifle in hand, making sure we were all safe.

Fortunately for us, elephants dont like to run up hills. We quickly made it to the top and were well out of harm's way. Bheki claimed no group had been that close to an elephant, and that certainly none had been charged by one. He hoped we would also be the last to have such an experience.

The rest of the days spent hiking were fortunately less eventful. We saw lots of different animals (see list) and generally had a good time. The only other scary event was a loud hyena outside our camp on the last night. It really did sound like he was about 10 feet away, and made a loud, funny howling-whine noise. But I was too tired at that point to really worry about it. Also saw some amazing lightning both nights, and I hopefully got a few good pictures of it with my 35 mm camera (which is why I cant post them yet).

So, you would think that of ALL the animals in the bush, at least a lion or a leopard would be the most dangerous. I thought certainly a rhino would be, or perhaps am angry water buffalo. But all these animals just ran away as soon as we got near them. They were terrified and wanted nothing to do with us. But the mighty elephant really wanted a piece of us, and would have certainly trampled us had we not gotten out of his way. Lucky for me, adrenaline apparently works well in females too, and we all made it away safely. (photos courtesy of Lisa B)

Fun with marshmellows and fire.

I think these two millipedes must have been wrestling or something. They seemed to be intertwined quite vigorously.

Our guides and the cook. Note the large rifle against the tree.

Kylie sent this picure to her parents and titled it "A Picture of Cully and Me"

Dung beetle rolling up his giant ball of animal poo.

White Rhino. Apparently they poop a lot, as we saw many more examples of rhino dung than actual rhino.

Me in tree.

What we saw in Umfolozi

White Rhino
Elephant
Giraffe
Zebra
Water Buffalo
Warthog
Impala
Nyala
Kudu
Water Buck
Family of Baboons (via binoculars)
Family of Lions (via binoculars)
Dung beetles
LOTS of horny millipedes

Email Blog

So this is supposed to show up on my weblog. I am writing it as an email to a top secret email address that should automatically post. We'll see if it works

Durban Surf

For some reason, there are no time zones in South Africa. This is a country almost twice the size of Texas, that is much wider (east-west) than it is long (north-south). Durban is close to as far East in the country as you can go. Thus, when you are very far east, and there is no time zone, it gets light out VERY early. Especially as far away from the equator as we are. Its not yet the peak of summer, but its completely bright out at around 5:15 am. This early sunrise will continue all summer long, until it supposedly gets light out around 4 am.

This is yet another reason to love surfing in South Africa. Add that to the fact that its pretty warm, there is almost always good surf, they have shark nets, surfboards are cheap, and you'd be crazy not to at least make an effort to surf in this city.

Kylie and I went to South Beach early this morning. I do prefer the break at North Beach, but it was a big swell today, and I thought this might be beter for her. And it was. She caught several nice waves and rode them all the way in on her feet (not on her belly as she had done a few times in the past). Even turned a bit on her massive board. Getting better at surfing takes a painfully long time, and I have to imagine its even harder for girls (I am awaiting 'Cully is sexist comments' now). So when you have a good day, you have to note it.

What I learned today

Drove up to Vulindlela today with Maloney, a social work student at the university. Was expecting another dull drive, but she was very talkative and interesting. I played her different songs from my new totally awesome mix CD. Very stupidly basing my intuitions about her music taste on the fact that she was a black South Africa, I thought she would definately have liked Jay-Z, Outkast, and the Beastie Boys. But much to my suprise, she liked Jack Johnson and Buena Vista Social Club the best. We talked about all sorts of things in the 3 hours of driving we shared and generally had a good time.

Maloney ended up being my translator for a very busy day at the clinic. We saw several patients, and I had to take all my own vitals which takes for ever. Seeing a patient in a research facility is a lot more time consuming as you have all kinds of forms and rules to follow. I miss a simple soap note on 1 piece of paper.

We saw one girl who was 14!!! I couldnt believe it! To make it even worse, she looked like she was about 7 years old. It was quite strange to be used to seeing so many HIV positive adults and then come across a child on antiretrovirals. She seemed pretty mature for 14, even if she didnt look like it. I carefully inquired as to how she contracted HIV, and she seemed to say she got it from birth. I didnt believe this, as she had only been on ARV's for 6 months, and most children born HIV positive die early on without treatment. Sadly, I think she must have been abused or raped at some point. But she had a pleasant disposition and it was so nice to work with a kid for a change. So easy to make them laugh and smile. I had to draw blood from her, and had to be extremely careful as she only had one vein that I could see. She was tough, and didnt even flinch. Luckily, I got it on the first try.

In the middle of the physical exam, another patient asked me (in Zulu, via Maloney as translator) if he could continue throwing up water in the morning while on ARVs. I also was very confused at this question. Luckily, Maloney explained that early morning emesis is a common Zulu remedy for many illnesses. Its prescribed by a Sangoma (a traditional healer, or witch doctor) and is apparently very prevalent. Sick Zulus apparently drink a large amount of water first thing in the morning, and then vomit the water up. They supposedly do this many times, and can swallow up to 15 liters of water in one morning. After having lived in Zulu territory for over 6 months (including previous visits) I had NEVER heard of this. Its called phalaza and I cant find much about it on the internet.

I was lucky to have Maloney as my "cultural translator." I find that even though some people may be able to translate between Zulu and English, I really need someone that understands both cultures in order to get anywhere. Zulu is a culture that is truly foreign to me, and I dont think I will ever totally understand it. Luckily, I have people like Maloney to help me along the way.

Had an amazing weekend on the game trail. Highlights included hearing hyenas outside our tent the last night, and being charged by an angry elephant. Will post lots of picutres and commentary soon.

UPDATE: Ligers are real

Napolean Dynamite drew a picutre of one, and led us to beleive that they were a fictional character "bred for their skills in magic." Yet Liger's are real. I couldnt believe it. A Liger is a cross between a male lion and a female tiger. They are apparently much larger that either animal, and don't occur in nature without human intervention.

Wikipedia link here.

Imfolozi

I am off to the Imfolozi game park this weekend. This a popular park in KwaZulu-Natal that is home to rhino, lions, buffalo, etc. We will hike to a camp on Friday evening (followed by park guides with big rifles, hopefully) and will camp there Saturday and Sunday evening. I have actually been to this park and a few others in South Africa, but have never seen a lion. I am hoping to see my first this weekend.

Again, I will find myself in the company of an all female brigade. 7 other girls, including Kylie, will be my camp-mates for the weekend. However, this time, I have grown a healthy beard to ward off any estrogen that may attempt to contaminate my male-dom.

Will post pictures of the weekend, my scruff, and hopefully a lion or two when I get back. If I am really lucky, maybe I will see a Liger.

Timing

I am not sure what it is about living in developing country that prevents everyone from giving you an accurate statement on when something will actually be ready. Maybe I am jaded after having dealth with this truth in so many places, but no one seems to be able to tell you exactly when anything is going to occur. And by that, EVERYTHING occurs after the estimated time.

Currently, I am sitting at home, unable to go to work because the mechanic working on our car has yet to complete his replacement of our clutch. This was a job that was supposed to be completed yesterday at 2 pm. Wary that they would not actually be done by then, I asked if they were positive they would be done by that time. They said, "oh, maybe 2:30 or 3 pm." I should have known that this really meant "whenever the hell we feel like it."

So its the next day. They said that would have it done by 9 am today, but at this rate, I am hoping just to get it back at all today.

This lateness is prevalent in almost all aspects of South Africa life. Packages arrive weeks after the intended date, internet is installed sometimes months after due, and people complete tasks with built in factor of lateness.

This really wouldnt be so bad if people were just honest about when something would occur. Just tell me its not going to occur for 3 months, and I wont get my hopes up. But its like everyone is afraid to tell you, so they give you a terribly unrealistic time. Maybe I just need to add a considerable amount of time to any estimate, and maybe I wont be disapointed so often.

Until then, I get to sit at home while the mechanic takes his time in replacing our clutch.

Some Good Links

These are just a few of my most recent favorite links. Very different, but all really good in managing the world of Cully. Maybe they can help you too.

Nation Master- this will likely replace the CIA World Factbook as my country information resource. Its pretty detailed, but easy to navigate. I used it to look up information on South Africa's crime rate. Great for comparing and ranking countries.

Magic Seaweed - This will be my new best friend for predicting whether to go surf at 5 am each day. Its got detailed wave size and period information and also taylors the wind direction to on or offshore. Will take a little getting used to, but it seems quite useful. I havent found a Galveston specific page, but there is a page describing Octagaon . I am assuming this is the Octagon Cam where netsurfing.com updates in Surfside, only 20-30 minutes from G-town. Durban surf report is here.

And one of my all time wierd favorites: superbad.

Google Yourself

Have you ever Googled yourself? I highly reccommend it to anyone who is either bored or narcissistic. Either pages about someone who shares your name will come up, or you will discover that you and your life is actually plastered all over the web. You're at a computer, go a head and try it. Just type your name in quotes and see what happens.

I also reccommend this for tracking exes, learning about new friends you may be suspicious of, or potential employers.

For example, I googled my new friend Anand Reddi only to discover his creepy personal ad on IndianFriendFinder.com. What a guy!

V-town...

...is the name I am trying to associate with Vulindlela among the locals around the office. Its CAPRISA's rural site about 1.5 hours outside Durban. I throw around phrases like G-town (Galveston), H-town (Houston), and Utopia (Austin), so why not shorten the cumbersome Zulu town down to this abbreviation. Needless to say, its not catching on.

So I was in V-town today. Saw several patients at varying stages of AIDS. All were in our treatment program and thus on HIV medication, but most started out with very low CD4 counts (and low in Africa is LOW, like 12, 4, and even 1). I am not sure how one only has 1 CD4 cell, and if so how they find it, but this is the case with several patients. Ok, I am kind of joking, the CD4 count is a cell/ml count, not an absolute, full body count.

Things went pretty well for the day. As I have in medical school, I try my hardest to go very slow with patients. If they see me, they get asked all kinds of questions and get all kinds of explanations. I make sure they understand what a CD4 count actually is. I always ask how they understand that HIV is transmitted. I think they arent used to being quizzed at the doctor's office, but they catch on pretty quickly.

The only drawback today was my interpreter/nurse, who will be refered to as R. I doubt this Zulu nurse checks out my blog very frequently, but just in case, we'll refer to her as R. Despite extremely frustrating translation challenges, R also made the following egregious medical errors:

-Subtracting 10 Kg from a patient's weight because he couldnt take off one of his shoes. Does anyone really think a shoe weighs 10 Kg, that is like 22 lbs!! She also failed to mention that she made this mental calculation, and I thought that the patient has lost 10 Kg in the past month until I weighed him again.

-Wrapping the blood pressure cuff around the patient's arm inside out so that as she inflates, the velcro comes apart. I showed her how to do it properly, and took the BP myself. I wrote it down as 122/68. She seemed stunned that I was able to discern anything on the sphygomanometer that was not a multiple of 10 (i.e. 120/70).

-Finally, a patient came in wrapped in a coat and sweatpants, was shivering despite the fact that it was pretty hot outside. R tried to tell me her temperature was a cool 36 degrees Celsius (totally normal). I told her this couldnt be right, and asked her take it again, this time leaving the thermometer in for longer than 12 seconds. She looked at the temperature and said "Oh my, this patient's temperature has gone up doctor!" The patient had a fever of 37.9. We later diagnosed her with pneumonia.

This, all coming from an "experienced" nurse who has worked in clinics her whole life. I couldnt believe all this, and began to wonder how reliable blood pressures and temperatures taken by South African nurses were in the past. Still, its hard to be angry at a doughty Zulu woman in her 50's who is oblivious to her medical mishaps. Deep breaths.

This is awesome...

A mix of Wookies and Baseball, what could be better?

This is a test blog entry

am having some trouble updating. Does this show up?

Swiming, Rugby, Surfing, Breeze

So, within an hour of getting our amazingly fast and convenient wireless network set up, I managed to switch the settings to "Security Enabled Network" and locked myself out of the network. Kind of like locking your keys out of your car. So we spent the weekend without internet because I am a moron. But, I managed to redeem myself this afternoon by resetting the network to only 64 bit encryption, and allowing all three computers to have full access. Now I dont feel so dumb.

Had a great weekend in Durban. Took it easy Friday night (this is when I locked myself out of the network) and woke early to swim on Saturday. Still trying to swim often when we are not surfing. I can go about 30 minutes doing (mostly) freestyle and dont feel like I am going to die every lap. I can also now swim the length of the pool (25 m) underwater without stopping for air. I am too afraid of drowning in the Indian Ocean to not to keep swimming and training.

Then we met Anand and Anup (2 Americans living here) to go to the rugby game in Durban. We luckily ran into our friend Sergio. Sergio runs Lizzard wetsuits and is our neoprene dealer in Durban. He also had access to season tickets to the Natal Sharks Rugby games, and happened to have 2 extra tickets. So enjoyed great seats in the sun, watched the Sharks battle the Western Province Cheetahs. Unfortunately, the Sharks lost, but it was a fun game regardless. We then went back to Anup’s for a braai (which really just means barbecue in South African English). We dined on some tasty spiced up burgers, and collapsed into bed. Long day.

Sunday we were awoken by the bright sun (it gets bright here around 5:30 AM) and saw that the wind was favorable for surfing. So we lugged the boards down to South Beach and surfed for a few hours. We stayed toasty in our new Lizzard wetsuits. Am getting better at catching smaller waves (2-3 feet) on my small board (8’0”). Caught several good ones in time to turn down the line and ride the unbroken wave all the way in. Making progress, but I still would place myself at the bottom 2% of surfers in Durban.

Now it’s a lazy Sunday afternoon. Its turning into Spring here, so its warm, breezy and sunny out. We cleaned the apartment and now have all the windows open. Kylie is reading the Poisonwood Bible (GREAT book) and I am enjoying the wireless internet.