Sanbona

Nicole from Houston

2007-02-23T04:02:00.000+02:00

Feel free to email me at cullywiseman at yahoo dot com and I will email you back.

Back in Galveston

2006-06-18T04:21:00.000+02:00

I am back in my beloved and simultaneously despised Galveston. The rest of the Morcocco, Spain, Portugal trip was amazing. Craig was a great travel partner and we saw and did a lot.

So its the end of my time in Africa for a while, but the work lingers on. My abstract was accepted to the 2006 International AIDS Conference in Toronto, Canada. I really wasnt expecting it to be accepted and thus planned my entire 4th year assuming that I would not attend. But of course, it was, and I had to make some major changes.

The first few months look a little like this:

Period 1: Move in, study for Step 2
Period 2: Actually study for Step 2, attend 2 wedding and the AIDS conference
Period 3: Emergency Medicine rotation at Denver Health
Sept 15, 16, 17: ACL Music Festival!!!
Period 4: Something easy...
Period 5:Trauma Surgery at UTMB

I should point out that period 1 and 2 are actually going to be pretty hectic. I have to move in, work at St. Vincent's arrange a complicated web of flights, trains, buses and car rentals to get me around between Toronto, Boston, and then back to Denver in time to start my rotation. Throw in the writing of a personal statement and running a clinic for the uninsured with 4 other medical students and you'd start to wonder how I would even have time to study for Step 2. In fact, I dont.

So now my question becomes: what happens to this blog. I am not in South Africa anymore and thus writing a blog called Sanbona doesnt make much sense. At the same time, I really want to keep posting ideas, thoughts, plans, even if no one reads it.

So I'll either keep writing here, or I'll start a whole separate blog to document my life as a 4th year medical student. We'll see.

Regardless, its actually nice to be back. Was sad to see my old medical school class graduate on June 3rd, but my new class is awesome and has been very welcoming so far.

Will be in touch!

Morocco

2006-05-22T13:09:00.000+02:00

So I have obviously been a way for a while. Sorry for that. I am currently traveling in Morocco with friend and Fogarty fellow Craig Connard. We met up in Marrakech and have been making our way north little by little.

Marrakech was an ancient city with a large and lively square. Here you can find street performers, story tellers, snake charmers, dancing monkeys, and traveling bands. The square, called Djenna El-Fna, is an overwhelming maze of interesting colorful people that seems to copme alive with sound and energy each day around dusk. There are also endless souqs or shops where you can buy everything from fresh safron to a fine Arabian carpet. Despite having asked several times, most vendors did not know of any magic carpets. I have yet to ask about genies, but have secretly rubbed several lamps in the hope of coming across one with three wishes to spare.

If you can think of any other Arabian myths and sterotypes that I can make into bad jokes, please let me know. I have already used the °rock the Kasbah° joke far too many times. I really need some new material here.

Next was Essouria (pronounced ess-way-uh), on the Atlantic coast. This was a very relaxed beach and fishing town with a wide stretch of coastline that was ideal for frisbee, soccer, and getting sunburned. We spent 3 days here dining on fresh grilled fish and cheap beers. Because of a lucky bet with our hotel owner on the outcome of the Barcelona Arsenal soccer game, we essentially stayed in our nice apartment for free.

We then met some of Craig's friends in the capital, Rabat. I wasnt expecting much, but this city was really amazing. We stayed at a friends house right on the ocean. The whole neighborhood was painted white and bright blue. It had a very mediteranean feel to it. We wandered through ancient Roman ruins, shopped for gifts, smoked the hooka with our new friends, (which, mom and dad, is very harmless tobacco...) and saw a great musician from Mali play in a 700 year old garden.

We have now made it to Fes, one of the oldest and largest imperial cities in Morocco. Inside the ancient city walls are over 9,000 twisting alleys, paths, and streets. We just arrived today, and havent yet been able to get completely lost yet. But if you dont get an email from me for a while, this may be why.

We will next head to Tangier where will then cross the straight of Gibralter into Spain. We plan on a few nights in Seville and a few more in Lisbon before heading home. This should put me in Texas around May 31st.

Am doing lots and lots of gift shopping and trying to gather presents for as many as possible. Please send me any special requests and I'll try to accomodate. Sending an email or leaving a comment on the blog (which are all forwarded to me via email) has been shown to increase your chances of getting something cool by 85 percent.

Regardless, I hope you all are well and safe and happy. While I am having a blast here, I am really looking forward to getting home and catching up with old friends and family. Stay well and I hope to see you all soon.

My mom met Bono

2006-05-06T09:23:00.000+02:00

I presented all my final data this Friday to the CAPRISA staff. Its been stressful week with managing 4th year of medical school plans, trying to squeeze in important weddings and conferences in between away rotations, and gettting ready to go home for good. Lots and lots to think about.

The presentation went for about 2 hours and went well, I thought. Though I was mentally exhausted by the end of it. Kylie and I decided to have an easy Friday night and rented a movie, ate some bunnies (bean curry in a carved out piece of bread, an Indian/Durnan classic), and took it easy. I started feeling sick just before bed, and had chills and a fever all night. Was not a lot of fun. I never get sick, and here I am.

I woke this morning with a nasty headache and body ache. I wanted to check my email, and it hurt to look at the screen. But I found this great email from my mom, and it made me feel a lot better:

Cully,
I got to meet Bono last night thanks to Karen and Phil! (my Aunt and Uncle) I went to a reception before he spoke to the World Affairs Council in Dallas.

I shook his hand and told him my son was doing aids research in s africa. he asked me your name and he said "I'll be thinking about cully wiseman, thank you for him." I said "thank you for all you are doing and for being here tonight." he said, "he is experiencing some hard things so thank you for cully."

He then gave a really fantastic presentation. I wish you could have been there.

mom

How cool is that? Bono knows who I am. Sure, I imagine he forgot 2 minutes later as I'm sure people say stuff like that to him all the time. Regardless, it hit me at a time when I needed a little something to make me feel better.

My head still hurts and I still feel pretty crappy, but not as bad as I did.

Tsotsi

2006-04-29T20:47:00.000+02:00

We finally went to see Tsotsi, a recently released South African film. The movie recently won an Acadamy Award for best foreign language film. Despite that accomplishment, I was still half expecting to see a movie that was good, but not great. I was suprised and can say that Tsotsi is one of the best movies I have seen in a very long time. It combines those key elements of poignancy and entertainment. It really makes you think and consider new points of view, but also keeps you entertained throughout. It would be great for anyone to see, whether they have been to South Africa or not.

On vacation

2006-04-21T18:33:00.000+02:00

I just got back from my first real vacation in Africa. Have taken plenty of extended weekend trips (like the last one to Cape Town), but this is my first week long trip. I met my dad in Johannesburg and we first flew to Kruger. We spent 2 nights in a SA National Parks camp and 2 nights in a private game reserve, Lukimbi Lodge. While the SANP lodge was very nice, it really paled in comparison to the private lodge. We then met Kylie back in Jo-burg and headed north to Livingstone, Zambia. There we stayed at a cool, rustic lodge and did the tourist circuit of Victoria Falls, a Zambezi River cruise, and a very cool gorge swing. Then we head all the way back to Durban so my dad could see where I lived, worked, and surfed.

While this short entry doesnt do the trip justice, I am short on time these days. After all, I leave very soon!! So I hope the following picutres at least provide a pictoral depiction of the trip.

This elephant was in "must" which apparently meant it was mating season and that he was really pissed off. He walked towards our Land Rover and made some menacing huffing noises. But we yielded to him, and this was about as close as we came to being sat on or tusked. It was pretty frightening though to be on the receiving end of such a large animal's aggresion.

Picture of me on the front of the Land Rover holding my favorite African beer, a Windhoek (pronounced vind-hook). a.k.a. the capital of Namibia.

Does this picture make you want to sing "cha-ma, cha-ma, cha-ma, cha-ma, cha-ma cha-meleon." It does for me.
The amazing view from Taita Falcon Lodge. We ate breakfast and dinner from the deck that looked over the Batoka Gorge. I was convinced I could throw a rock over the edge to the river. Despite multiple attmeps, I never really even came close. Now my shoulder hurts.

Incredible Victoria Falls. We visited just after the rainy season at the peak of the flow over the falls. The spray from the falls was quite intense. It was a beautiful, sunny day, yet it felt like a full on hurricane in dark stormy weather. Pretty amazing.

The intrepid traveling trio about 30 meters upstream from the falls. Notice the massive spray behind us.

My Dad and I, shortly after we convinced him to try the gorge swing in Zambia. We were actually quite proud of him for giving it a try. While I obviously managed to shave in the time between the previous 2 pictures, I am, infact, wearing the same smelly shirt.

Me making the jump off the gorge swing. Was a little scary the first time, but pretty fun once the swing caught you.

Can you believe there was a 30 foot scorpion outside our room in Zambia? This was one of the many intimidating bugs we had to contend with at our rustic lodge.

And finally, back to civilization in Durban. Kylie set up an amazing dinner for us at a nearby Thai restauraunt. We invited all our friends and had dinner for 12. The food, the company and the atmosphere were all amazing. It was probably one of my favorite nights in Durban. Note Nupe at the far end of the table. He's been back in SA for a few short weeks and we were happy to have him around.

The other side of Florida Road

2006-04-07T22:11:00.000+02:00

So, you might recall my entry about our beloved Florida Road. I had described it as a fun, safe oasis in Durban where you can stroll from bar to restauraunt and forget that you are in one of the most dangerous cities in Africa.

That is unless you were strolling tonight and encountered the knife fight that happened no less than 20 feet from our restaurant. I present it here in a somewhat lighthearted manner, but a the time, it was anything but.

We first noticed a gathering of police cars around one of the cross streets that we use to get to Florida Road from our house. We were a little worried because while we always considered Florida road to be safe, the cross street (really more of an alley) is dark and a little scary. So we wanted to know if anything had unsafe happened on our somewhat hidden shortcut.

We saw police and a medic hovering around a particular corner outside a restaurant. They seemed concerned and were talking on their radios and walking around briskly. Their actions seemed rapid and purposeful. Then we noticed they were carefully stepping over a body that was laying on the sidewalk. We were shocked to see a black man on his back with his limbs sprawled out awkwardly around him. After a careful look, it was clear that he was not breathing.

Not know what else to do, we just stood there and stared. I couldnt believe what I was seeing. It was hard to believe that a man was lying dead on the sidewalk where we so frequently walked. We asked some people what had happened, and they said that two car guards had gotten into a fight and one was stabbed in the heart.

A car guard is a very common job in South Africa. They stand and wait in your parking lot while you are away, ostensibly to prevent crime and theft. You typically give them a few Rands when you return. They range from very official car guards with uniforms who are often employed by a shopping mall, to the unsavory, often drunk ones that you only give money to because you are afraid they might attack you if you dont.

Apparently, two of them had gotten into an altercation over who deserved the 3 Rand tip (about 50 cents) and one was stabbed as a result. There was no blood on the sidewalk and I imagined the man was stabbed in the heart, causing it to stop pumping instaneously. It occured literally a few steps from a popular Italian sidewalk cafe. It was tragic and surreal to see the lifeless body on the pavement next to a crowded restaurant full of white diners. Unbelievably, most of them continued to eat, not paying too much attention to the commotion.

So this was our first real brush with crime and violence in Durban so far, and I am hoping it is our last (yes, I just knocked on some wood). While it likely doesnt happen very often on this side of town, I unfortunately think its not too uncommon of an occurence in Durban. It still seems like an unreal scenario and one I likely wont forget.

I just looked over my old post about Florida Road (see link above) and it seems quite ironic that I had been so recently touting it as a safe, fun, hip place to spend an evening. Kind of makes me feel trite and superficial after what I saw tonight. Unfortunately violent crime has become a real part of South Africa, whether it occurs in the townships or on Florida Road.

10,000th day in Cape Town

2006-04-01T14:12:00.000+02:00

Today is my 10,000th day. Having calculated it a few months ago (at timeanddate.com) I knew that it landed on April 1st. Kind of ironic, but true. 10,000 days is 27 years, 4 months, and 18 days. Perhaps yours has passed you by, or maybe its just around the corner, but its worth noting either way.

I am currently in Cape Town, over on the west coast of South Africa. Its truly one of the most beautiful cities on the planet. Set on a long peninsula with a 3,000 foot mountain range in the middle. Its a very progressive, exciting, cosmopolitan city that still has close ties to nature, the ocean, and the environment. You come here to visit, and immediately start thinking of how you might be able to find your future job here some day.

We spent the morning driving down the cape peninsula, stopping at some beautiful beaches along the way. We drove up a windey steep road to Chapman's peak with stunning views of the sea and mountains to the right. Then we stopped off to see the penguins at Boulder's beach in Simon's Town.

After lunch and an ice cream cone, we are now heading to the Cape Town International Jazz Festival. Hoping the rest of the day will be as fun as the first half. What a great way to spend my 10,000th day.

Three Years of War

2006-03-21T12:48:00.000+02:00

March 19th marked the Iraq war's 3rd anniversary. I remember well March 19th 2003 when the war actually started. I was a first year medical student struggling through my neuroscience block, but keeping an eye on the news via the internet.

I remembered being appalled by Bush's insistence that we must invade Iraq. I remember him pleading to the UN for permission to once again invade the country. The UN sent their investigators to look for weapons and found none because their were none. They voted not to allow the US to invade. But we invaded anyway. I was shocked and saddened that our country would subvert the UN's doctrine. It made the statement that we are the exception, that the rest of the world must abide by the UN's rules and regulations, but we do not have to.

I thought for sure time would prove me wrong. I thought that we would find the chemical weapons plant making awful gases and missiles loaded with anthrax. I wanted the US to find them. But they didnt. We found Saddam, but never saw any of his missile silos or nuclear weapons. Its bad enough to ignore the UN and insist that we are right. That we turned out to be wrong in the end, is shameful.

And here we are. Three years and over 33,000 civilian deaths later. What have we accomplished? I wont say nothing, because some good has come from our invasion. We took a madman out of power. We freed a country from tyranny, sort of. They had elections. All those things are good, I am not discounting that. However, there is still widespread poverty, crime, and violence in Iraq, and progress has been very slow, to say the least.

But my real concern is with how the world and history will view our actions and our priorities. We have set the precedent that its ok to ignore the UN when you have a really strong hunch about a country's intentions. Unfortunately, we have also set the precedent that its ok when that hunch is dead wrong.

More importantly, it says to the world that the US will invade who we want, when we want, primarily because we can. It says we will ignore events like the genocide that occurred in Rwanda and that which is occurring in Sudan today. We will spend 250 billion dollars, will sacrifice over 2,000 of our young troops to defend our interests. We will only donate a fraction of our war expenditure to the worst plague the world has ever known.

$250 billion dollars would fund worldwide AIDS treatment for 24 years. I worry not only about the US, but about the entire human race when I realize how much we spend on killing compared to that which we spend on helping.

So you may not agree with my statistics or my logic, and that is fine. Either way, I hope Americans take a critical look at what is going on in our world and what the United States role has been in it. We have been at war for three years now. Its time for us to think about that, and decide if its something we support, or perhaps something we now see as a mistake. Let those thoughts and decisions influence your politics, your vote, or even your words and actions. I obviously only present my views here. On this anniversary, I hope you are able to take a close look at our world, and a deep look into yourself, and develop your own.

Shepherd's Keep

2006-03-19T13:29:00.000+02:00

Since we've been back in South Africa in 2006, Kylie has been working as a nurse at an orphanage here in Durban. Its called Shepherd's Keep and is located on the other side of Durban in an area called the Bluff. Shepherd's Keep is a privately owned and funded orphanage for abandoned infants. Most are less than 6 months old. Many were found in parks, wrapped in plastic bags, in public bathrooms, all discarded like unwanted property. As a result, many of them have anoxic brain injury and/or cerebral palsy. Some will hopefully grow up to be healthy happy adults, others will have permanent dysfunction and fail to fully develop normally.

We visited Shepherd's Keep a few weeks ago and took some of the pictures below.
This is a picture of Kylie and Sibusiso. He is 7 months old and has been at the orphanage since birth. He is a very healthy baby and has hit all his developmental milestones on que. Currently he has no foster parents.
Zuma is 14 months old. He was brought to Shepherd's Keep when his mother was sent to prison. The orphanage had been doing the paperwork for Zuma's grandmother to adopt him. The mother will likely be able to stay with them once she is out of prison. Luckily, Shepherd's Keep was around for him during the interim period.

This is Princess (the baby) with Happiness (the caretaker). There are about 6 caretakers looking after 16 babies at any given time. None are actual nurses (Kylie was the first) but all are certified caretakers. They get paid about $5 a day to work at Shepherd's Keep. Keep in mind "a day" usually starts at 6 am and ends at 7 pm. Kylie thinks they could all use a raise.

If you'd like to make a donation to Shepherd's Keep, please click here. You can rest assured that your donation will be going to a good cause. Might even help the caretaker's earn a fair wage.

Match Day

2006-03-17T09:50:00.000+02:00

Yesterday was match day for medical students throughout the country. On this fateful day, every 4th year medical student recieves notifcation of where they "matched" for residency. After having spent much of their 4th year applying and interviewing at various residencies, med students finally discover which residency has decided to accept them as a new doctor and a new employee. Its a very important and very nervous day for most everyone. These agreements are binding and once the student has matched, they must work at their assigned location. Many students feel that match day is the culmination of all they have worked for as a medical student.

At UTMB, all the students gather in an auditorium. All the envelopes indicating the student's residency are tossed randomly into a jar. One by one, each student is called out to collect their envelope. When they do, they put a $1 bill into another jar. The last student to be called gets the money. The second to last gets the pity of the class.

I lived through the match vicariously as had I opted to stay in America, I would have likely been a part of it all. I emailed all my friends to find out where they had ranked. I wanted to be as much a part of it all as I could, despite the vast distance between Galveston and Durban.

So this morning I found the match list on the UTMB website and read it carefully. For some reason, I was nervous. I knew so many fates had just been decided, and I wondered who was going to be disapointed, who would be elated.

All in all, the results looked promising. Most all of my friends got their 1st or 2nd choice. Many people matched in competitive fields like plastic surgery, orthopedics, and (ughh) dermatology. Others matched at competitive places like Duke, UC San Diego, and the Mayo Clinic. It was great to read about the sucess of my former classmates, and I am truly proud of all of them.

I googled "match day" and came across this article in the New York Times about match day at Cornell. I imagine their match day was quite different than UTMB's, what with the hotsy totsy champaigne and fruit and cheese brunch.

AIDS Article

2006-03-16T07:16:00.000+02:00

Found this article on news24.com about South Africa's AIDS crisis. Here are some important points if you dont feel like reading it all. Many I already knew, some were new to me:

-With over 5 million infected, South Africa has more HIV positive citizens than any other country on the planet

-Currently, about 500,000 people in South Africa urgently need antiretroviral therapy. I assume this means that 500,000 have CD4 counts below 200.

-The government and/or private agencies are treating around 200,000 leaving a deficit of 300,000 that will go without therapy and likely die from AIDS related illness as a result.

-50,000 children need ARV's, but only 10,000 are receiving it. (Personally, I would be suprised if 10,000 children in South Africa are on ARV's as I have encountered only one in my entire time here)

-One of the interviewees also argues that AIDS therapy should start at a CD4 of 350, not 200. I tend to disagree with this. In my study, those with CD4 counts in the 100's do just fine on ARV's. They respond well, they have good viralsupression, and low mortality. On the other hand, those who wait until their CD4 count is below 50 have a significantly increased risk of death and treatment failure (this is essentially what my paper is about).

Anyway, I am glad that the independent news is constantly talking about AIDS, even if many are tired of hearing about it (even myself at times). I think the SA government has fallen short and its up to the media to continue to make people aware that AIDS in South Africa is a pandemic of historic proportion.

Negative

2006-03-15T13:05:00.000+02:00

My PPD test is NEGATIVE. Zero millimeters of induration. I dont know how in the world I managed to avoid tuberculosis while I was here. I've been around dozens of patients with active, hacking, TB cough. Heck, I did most of my research at a TB clinic! Regardless, I am negative. That's my story for now and I am sticking to it!

AIDS disability grant

2006-03-15T09:08:00.001+02:00

I came across an interesting patient yesteday at Vulindlela. She was a mother of 4 and had been on antiretrovirals for a little over a year. She had a less than expected CD4 count response to the ARV's, but good viral supression. Essentially this meant that the AIDS medicine she was taking was keeping the virus from replicating, but her immune system was not coming back to life the way it should be. She was there with her youngest daughter of 2 who was also HIV positive, though not on any antiretroviral medicine. The mother still had some disability in the form of excessive faituge, skin problems, anemia and weight loss. After we discussed all the medical details, I began asking her how she supported her family and children.

Her husband had died a few years ago and she was simply too ill to work. Her children were too young to have jobs, and instead needed to be in school and looked after constantly. How is a single mother of 4 who is sick with AIDS supposed to find a job in rural South Africa? Under most circumstances, such a situation would be devastating to a small family. However, the South African government has instituted an AIDS disability grant for HIV positive patients that are too ill to work. Thus, this patient had an income of about $180 per month. Raising a family of 4 on what amounts to about a $2,000 per year income is certainly not easy, but it is much better than nothing. I realized that this small struggling family would have been lost without this grant. I was actaully quite proud of South Africa for deciding to support their disabled HIV positive population.

There is a small problem I forsee with the issuing of an AIDS grant. Only those with clinically defined AIDS are eligible for the grant. Thus, the patient's CD4 count must be below 200. Once the patient starts on ARV's and the CD4 count becomes above 200, they are no longer eligible and are expected to go find work.

This obviously presents a conflict of interest between taking your antiretrovirals and recieving your monthly grant. Indeed, I have told patients about the "good news" that their CD4 count has risen to 250 or 300, only to see them break down into tears because they know they will no longer be eligible for their AIDS grant. I have also heard of patients refusing to take their ARV's regularly to prevent their CD4 count from getting too high. Such behavior can have devastating effects on the patient, and on the course of the epidemic as it may foster viral resistance to the medications.

I dont really know the solution to this probelm. The SA government obviously needs to prioritize who recieves finacnial support, but by designing such a strict cutoff, you may also cause some major problems for an individual, and may worsen the epidemic itself. Regardless, I was happy that this patient had some financial support. I think its the humane and right thing to do if your government has the means to do so. For this family, it may have meant the difference in subsistence and starvation.

Honesty and email

2006-03-14T06:41:00.000+02:00

Kylie and I had been planning for weeks that one of her friends from college would come out to South Africa and visit us. I'll graciously refer to her as Ms. X from now on so as to protect her identity. Kylie and Ms. X had plans to drive from Durban and Cape Town and do some scuba diving along the way. I was going to come a long for some of the trip. Flights were bought, rooms reserved, and Kylie even spent two weekends taking a diving course just so she could dive with her friend. We were all excited to see Kylie's old friend and show her a good time in South Africa.

The plan was that Ms. X was to going to visit her boyfriend in Florida just before her trip to South Africa. She emailed us from Florida saying she was about to head back home to pack and leave for her long flight to Durban. However, the morning that Ms. X was to leave, we got a very flustered email from her saying that she had lost her passport and could not make the trip. She seemed very apologetic and upset by the whole thing. Naturally, Kylie was too. We had been planning for weeks on her arrival, and this changed everything considerably. We scrambled to salvage what we could of the reservations, but ended up losing some money as a result.

I have never met Ms. X, but knowing what I know about females, I suspected she was lying. No one loses their passport 6 hours before a flight. I figured she decided to stay in Florida and simply didnt want to confess that she had ditched us for her boyfriend. Luckily, knowing what I know about computers, I thought I could prove it.

What Ms. X didnt realize is that every email has kind of "envelope" on the outside called a header. The header tells you a lot about where the email is going, and where it has been. Instead of physical addresses, the internet uses IP addresses. These IP addresses can easily be looked up and the actual, physical location that the email was written can be discerened.

So, with Kylie's permission, I looked at the header of Ms. X's email. It was supposedly written from her home in Washington DC amidst the confusion of her lost passport. However, when I looked up the IP address, this is what came up:

IP Address	Country (Short)	Country (Full)	Flag	Region	City	ISP	Map
216.106.180.10	US	UNITED STATES		FLORIDA	FT. LAUDERDALE	STS TELECOM

We can thus assume that she never left and had made up the whole story about her losing her passport as a cover.

Because Kylie is the sweetest, kindest person on the planet, she wouldnt confront her friend about it. She really wasnt even all that mad, though I think her feelings were hurt. She just played along with the story and said that these things happen. I thought she should have confronted her, but Kylie resisted the temptation. That is why she is such a great friend and good person.

I think this story teaches us somthing that we have always known: be honest! Sure, it would have sucked to email Kylie and explain that you have decided not to come to South Africa and stay with your boyfriend in Florida. But it would have been much better than lying about it, and getting caught. So if anything good can come out of Ms. X's bad decisions and my internet snooping, maybe its the realization that in most cases, the truth is a hell of a lot better than a lie, especially when it comes to your friends.

Also know that your emails can be traced with a minimal amount of effort. In fact, here are two sites that will teach you how to do it: This site shows you how to find the IP address of the sender. This site allows you to look up the IP address and will give you a print out like the one above.

So be good and honest to one another and hopefully you will never need to even use these sites.

Cully's PPD Placement

2006-03-13T14:05:00.000+02:00

I just had a PPD skin test done to check for a latent tuberculosis infection. For med students, you already know what this is. For the rest, please allow me to explain.

Almost 1/3 of the world's population (2 billion people) are currently "infected" with TB. Now, this doesnt mean that they are sick. The vast majority of these 2 billion have what is known as latent tuberculosis. This means that theoretically, someewhere in there body there are TB bacteria that may someday wake up and actually cause the disease. This should not be confused with actual pulmonary tuberculosis, which innvolves night sweats, weight loss, coughing, and is highly contagious. Latent TB is not contagious. However, there is a 10% lifetime chance that those with latent TB will someday develop pulmonary TB. The chance is 10% each year for those with HIV.

To check for latent TB, a small amount of inactive TB is placed under the skin in the form of purified protien derivative (PPD). If your body reacts to the antigen, it is presumed that you are latently infected. You then need a chest X-ray to rule out active disease that may be contagious. Now, here is the awful part. Those who have a positive PPD will have to take a drug called isoniazid (or INH) for 9 months. INH is a toxic drug and is hard on your liver. People often develop tingling and burning in their toes and fingers while on INH. But worst of all YOU CAN NOT DRINK ALCOHOL WHILE TAKING INH! I know, isnt it terrible! Thats like being pregnant!!

In order to be allowed to rotate at USC this fall, I have to have a recent PPD placed. Mine was just injected under my left arm, and I am now PRAYING that it will not react. Please send all your positive energy, prayers, health chakras, etc to my left arm. Not only do I not want to have any TB bugs hiding out in my body, I really dont want to take INH for 9 months.

I'll know in 48-72 hours if its positive or not. Stay tuned to find out the exciting sequel to "Cully's PPD placement." Hopefully, it will be as boring and uneventful as it sounds.

Next day

2006-03-10T13:13:00.000+02:00

Went back out to surf this morning and the waves were still up from the cyclone spinning way off the coast. The swell was still coming in, though not quite as large as the previous days. Plus the wind had settled and it was glassy smooth. I realized in my last post, I might have come off sounding perhaps a little un-intrepid (if there is such a word). I also realized that despite all my talk of surfing, I have never posted any actual photos of me in the water. After all, I could be making the whole thing up. Luckily, Kylie snapped this photo from one of the piers. I had to zoom in quite a bit, but if you look closely, you can tell its my behind bent out awkwardly.

This actually isnt one of my best moments. I am surfing a right, which is backhand for me (my back is to the wave) and the angle of my board is not pointing far enough to the right. I kind of skid down this wave at an angle, but had I turned right harder, I could have stayed on the face longer and gained more speed. Still, its a decent shot and much thanks to Kylie for taking it.

And no, I didnt take the other surfer's head off who is paddling out of my way in the foreground.

Southern cyclones and fear

2006-03-09T06:44:00.000+02:00

In case you cant tell, this is a map of the southern tip of South Africa and Madagascar. Pressure bars and wind patterns are superimposed. The big orange circular thing on the right is a massive cyclone spinning just SE of Madagascar. A cyclone is essentially the same thing as a hurricane, a huge mass of coulds spinning around a low pressure area. But here in the southern hemisphere, cyclones spin in the opposite direction (clockwise) just like the toilets do. Its called the Coriolis effect

This cyclone is in perfect position to be spraying Durban with lots of swell. The system has two important aspects to wave generation: its very powerful with a low central pressure and there is a long distance between the storm and the shore. Its just starting to be the end of summer and the beginning of winter here in Durban, and the wind and waves are beginning to pick up.

This particular storm is causing pretty big waves in Durban. Nothing like the waves we saw last November at the Goodwave competition, but still powerful and tall. I paddled out yesterday afternoon and was a little frightened. Most sets were medium sized waves, around 4-6 feet. But then a big 8 foot set would come through and, to be honest, it scared me a little bit. I still have a strong respect and pretty healthy fear of the ocean. I looked around me at the handful of other surfers around, and decided I was in over my head. I fought the current for a while, and finally caught a smallish wave all the way to the beach.

Its always hard to tell if you are playing it smart, or just being a big pansy. Its such a fine line in surfing and in life. The balance of caution and hazard is something we deal with everyday. In this case, my perhaps exagerated fear of the powerful sea was too overwhelming and I decided to play it safe. Whether it was the right decision or not, I'll never know. Such is life.

Two articles

2006-03-08T09:50:00.000+02:00

Two fantastic articles from the New York times.

The first, I must give credit to one Anand Reddi. He sent me this article about the wild optimism and relentless hope that seemingly all Africans share despite the disease, poverty, and civil unrest that plagues so many of their countries. I found it particularly poignant considering the last entry about Michael's party. There also seemed to be a shared belief that the bright future they had always hoped for was just around the corner. For many at that party, that bright future might have already arrived. Their situation is really quite promising compared to the refugee fleeing Sudan with her 3 month old child in this article.

The second is another Times article about the growing number of HIV positive children recieving antiretroviral therapy in Sub-saharan Africa.

Both capture a struggling, yet hopeful Africa. Their fight for peace, for health, and for well being is far from over. But I believe their optimism and resourcefulness will one day bring them into a brightened future when we no longer consider Africa to be the Dark Continent.

Unveiling

2006-03-08T07:15:00.000+02:00

While we obviously live in Durban, we are, after all, in the province (or state) of KwaZulu-Natal. KZN is home of the Zulus and has more Zulu speakers than anywhere else in South Africa. You wouldnt know it by driving around the nicer neighborhoods in Durban, but the province is steeped in Zulu culture and tradition dating back thousands of years.

We felt very lucky to have been a small part of this tradition last weekend. Michael, a close friend to the family from whom we rent our house, invited us all out to his family's "unveiling." I have been a part of these ceremonies before, but still dont have a full understanding of what they are about. From what I can gather, it innvolves the slaughter goats or cows on a Friday evening, along with some ceremonial proceedings. These are usually watched over closely by a Sangoma (a Zulu witch doctor or traditional healer). Over night the animal is skinned, cut to pieces, and hung up to be drained. The next day an enormous party ensues as friends and family from all over come to eat the meat, vegetables, and drink lots and lots of beer.

Typically, I think this ceremony is meant to honor a deceased ancestor, as well as to honor a living family member. In this case, Michael's family was commemorating the one year anniversary of his mother's death, but also celebrating the life of his brother. Below are a few of the many pictures we took of Michael and his friendly family.

Lots and lots of meat. I am still doubtful that they were able to consume 2 whole cows over the course of 2 days, but they certainly made progress while we were there.The whole family.
I have now been to 3 of these parties in my lifetime. There is ALWAYS a group of men, off on their own, sitting around a pile of meat on a cutting board.
There also seems to be a tradition among the men to get totally wasted. As the afternoon wore on, the men in this tent became more and more intoxicated. They seemed to forget that they didnt speak English, and we understood next to no Zulu. This didnt stop them from having lenghty conversations with us.
The aforementioned tradition was also shared by many of the Zulu women.

The younger kids really seemed to look up to us. Especially when we were standing on chairs and taking their picture.

As we were leaving, we discovered that this woman's sweater was likely forged in our home state. We pointed to it and tried to explain that the shape she was wearing was a place called Texas. We even found a translator to explain it to her. I'm not sure, but I think she thought we were claiming to have once lived in her breasts. Either that, or she just wasnt very impressed. More likely the latter actually.

All in all, we had a great time with Michael's family. Despite the immense cultural barriers, and even more immense language barriers, they really made us feel at ease and welcomed us into their home. They very graciously shared as much food, beer, and cow as we were willing to eat. In exchange, we gave them the dozens of photos we took over the weekend and have now made them world famous by posting them on the internet.

Zuma pleads not guilty

2006-03-06T14:03:00.000+02:00

I wasnt suprised to read this article in the BBC that Zuma has pleaded not-guilty to charges that he raped a family friend. As you may recall, Jacob Zuma is the former deputy president of South Africa (equivalent to a vice-president). However, he was recently asked to resign from his positiong due to innvolvment in a corruption scandal and this rape trial.

Do I think he is guilty? Yes, I imagine he raped that girl and that he was innvolved in the corruption and cover up. Do I think he will be found guilty? Not likely. Do I think he will succeed Mbeki as the next president of South Africa? Tragically, I think that he will.

I worry about what kind of message this sends to a country that is already embarassingly lenient on the persecution of rape victims.

South Africa has so much promise as a leader on the continent. I hate to see that opportunity lost to corruption and scandal.

Zimbabwe

2006-03-04T18:04:00.000+02:00

When I wrote my last post on the SA elections (see below), I made the comment about a potential "Zimbabwe-esque" situation. I even searched for an article that would sum up what Mugabe has done to his country, but couldnt find anything in the 16 seconds I allotted myself to search. But today I came across this article in the BBC, which I think sums up what a dire situation they have in Zimbabwe, and why it is directly related to the decision Mugabe made that made it legal for blacks to seize white farmer's property.

Election Day

2006-03-02T16:48:00.000+02:00

Yesterday was election day in South Africa. Unlike in the United States, all of South Africa votes on the same day. This means that it is treated like a national holiday and no one has to go to work. Even us Americans who clearly are not able to vote.

Persosonally, I think the good old RS of A (Republic of South Africa) has one of the most fascinating political situations in the world. I’ll try to share a little with you now, along with a healthy dose of my under-educated opinion.

First of all, South Africa has only had nationwide elections since 1994. Prior to that, blacks were not included in the election process. Thus, most people really seem to value their vote here as people indeed died for that right. Thus, South Africa tends to have a very high voter turn out.

The first party to really gain power in 1994 was the African National Congress (click here for an unbiased description) and they have dominated the political scene ever since. The ANC fought against apartheid in South Africa for decades and was Nelson Mandela’s party when he was elected in ’94. Today, Thabo Mbeki is the current president, and also a long time ANC veteran.

I have mixed feelings about the ANC. I appreciate that delivery to the poor is a fundamental aspect of their platform. I do think they are making great efforts to expand housing, electricity, and water to as many rural South Africans as possible. However, there is certainly an anti-white tone to much of their propaganda. They seem to still have some underlying resentment left over from the apartheid era. This may be understandable, but it really has no role in creating a unified, successful South Africa. No matter what occurred in the apartheid era, scaring off the white population of South Africa will undoubtedly result in a Zimbabwe-esque situation.

Further, the ANC has been subject to multiple scandals as of late. Vice president Jacob Zuma has been charged with corruption and has been accused of using bribery to try to cover up the allegations. He is also currently on trial for the rape of a 31 year old girl AIDS activist. He has since resigned from his vice presidential position.

I also have a tremendous problem with the way the current president, Thabo Mbeki has handled the AIDS crisis in his country. Currently, South Africa has more HIV positive individuals (over 6 million) than any country in the world. Yet, Mbeki continues to insist that there is no crisis. He only recently admitted the “possibility” that AIDS is in fact caused by HIV, rather than stubbornly clinging to his previous beliefs that AIDS is simply a "disease of poverty." I have particular issues with this beyond the obvious, as I was working in prevention and education in South Africa in 2001 when Mbeki made such outlandish claims. I had many students ask me if their president was right in saying that AIDS cannot be transmitted via sexual contact. His failure to act decisively amidst the AIDS crisis and his obviously fallacious comments will likely be responsible for thousands, if not millions of new HIV cases and AIDS related deaths. His failure to act amidst the most devastating epidemic that humanity has known is shameful and tragic.

The major opposition party in South Africa is the Democratic Alliance (click here for an unbiased site). They are a primarily white party whose primary role seems to be to expose the shortcomings of the ANC. The are truly the underdog in SA politics as they are almost always 2^nd to the ANC in every election. In theory, I agree with their mentality to create a unified, stronger South Africa that will benefit all races. But they don’t provide too much information on how. In fact, the majority of their publication seems to focus only on the ANC's mistakes. Still I have realized that even if they never win an election, their mere presence makes South Africa more democratic. Their ability to expose any corruption, broken promise, poor governing, etc within the ANC forces the ruling party to stay in shape. Kind of a check on their power, forcing them to provide tangible improvements int he lives of South Africans. I would really worry about how the ANC would behave if the DA were not around to at least threaten them with an upset.

Currently, it looks like the ANC has pulled off another landslide victory, despite the recent controversy.

Anyway, that is enough about politics here. Likely not too interesting to the lay reader. Sorry for that. If its any consolation, I spent the day surfing and lounging at the beach. We started at 8am in our usual surf spot and then moved to another beach in the afternoon. It was a very full, exhausting, fun election day for me and my friends.

Toronto

2006-02-27T19:57:00.000+02:00

Last week, I submitted an abstract to the XVI International AIDS Conference in Toronto, Canada. I had expected just to throw something together, but this actually took up a good bit of my time. It was really difficult to keep it under the 300 word minimum. It is the result of work I have been doing for the past several months, so its kind of a brief summary of what the heck I have been doing over here. I am actully slightly proud of it, but know that it is one of 12,000 abstract submissions to the biggest AIDS conference in the world. I belive my chances of being accepted are quite slim. Regardless here is my official submission:

Response to highly active antiretroviral therapy among patients with CD4 counts below 50 cells/mm³ in a resource-constrained setting

Background: AIDS patients in the developing world often present for HAART with lower CD4 counts and more advanced disease. This study provides data on how patients with advanced AIDS respond to HAART in a resource-constrained setting in South Africa.

Methods: Fifty HIV+ patients with CD4 counts below 50 were paired with sex and age matched controls with CD4 counts above 100. Non-ambulatory patients with complicated opportunistic infections or Karnofsky scores below 70 were referred out. All patients were initially commenced on a once daily HAART regimen of efavirenz, lamivudine, and didanosine. Patients were seen by a clinician monthly. CD4 count and viral load were measured at 6 month intervals.

Results: The mean baseline CD4 and viral load of the CD4 below 50 group was 22.5 cells/mm3 and 363,795 copies/ml respectively, while that of the CD4 greater than 100 group was 151.7 cells/mm3 and 286,577 copies/ml. During the first 10 months of therapy, 8 patients in the CD4 below 50 group and 1 patient in the CD4 greater than 100 group died from AIDS related illnesses. After 6 months of therapy, 64.8% of the CD4 below 50 group and 97.8% of the CD4 greater than 100 group achieved complete viral suppression. The 6 month CD4 count increased to 137.0 cells/mm3 in the CD4 below 50 group and to 271.6 cells/mm3 in the CD4 greater than 100 group.

Discussion: The risk of death for patients with CD4 below 50 was RR 8 (95% CI 1.5 - 42.7) compared to the CD4 greater than 100 group. Among the 8 deaths, 6 patients died within the first 2 months of therapy. It is likely that these patients presented too late for treatment and never underwent complete immune reconstitution. Among the survivors, fewer patients in the CD4 below 50 group achieved viral suppression at 6 months [RR 0.7 (0.5 - 0.8)]. These findings highlight the importance of identifying AIDS patients at an earlier stage of disease with CD4 counts greater than 100 for initiation of HAART.

Update on Lindiwe

2006-02-25T17:27:00.000+02:00

I had written previously about a young girl named Lindiwe who came to our clinic with advanced AIDS. When I first met her, she had a CD4 count of 2 (normal is 1,000, below 200 means you have AIDS), could barely walk, and was severely dehydrated. For the past 3 months she had been too nauseous to keep food down, and anything she ate was likely not absorbed due to her chronic diarrhea. This situation also resulted in her being continually dehydrated. For months, she presented to several Durban hospitals in a dangerous dehydrated state. While these hospitals would stabilize her with IV fluids, they rarely admitted her over night, and never even mentioned the prospect of ARV (antiretroviral) medication.

Sadly, patients like Lindiwe are extremely common here. You have a whole group of AIDS patients that are dangerously ill. Patients like these need ARV medication, but it must be administered by an experienced clinician while the patient is in the hospital. These patients are so volatile, that the addition of ARV's might actually kill them. As a result, they are essentially neglected by any ARV rollout where they attempt to seek therapy. No clinic would want to start them on ARV's for fear that they might die in between visits. Thus they get refered to hospital, where they get an IV and are quickly rushed back out the door.

Lindiwe needed to be hospitalized and started on ARV's, but I knew that if I sent her to the local hospital, she would not get the care she needed. I also knew it wasnt safe for us to start her ARV medication as an outpatient. So, I cheated, and called Dr. Yunus Moosa to see if her would take her.

Dr. Moosa possess the rare combination of clinical brilliance, unyielding determination, and powerful dedication to his patient's health and well being. I truly think there are very few like him in South Africa. He somehow manages to practice quality medicine in a place where the roadblocks to doing so are many. When the lab fails to provide his patient with a result, he calls them from his cell phone while waiting on the ward. If a nurse fails to carry out his orders, he brings her over to the patient, and watches her administer medicines or start an IV. Despite all the odds against them, his patients get better.

I knew if Lindiwe was going to survive, he was her only hope. It took one well timed phone call, and we managed to get Lindiwe onto Dr. Moosa's service. Due to her immunocompormised state, Lindiwe had developed a tuberculosis infection of her abdomen, a viral infection inside her eyeball, and a seemingly unrelenting case of chronic diarrhea.

Lindiwe spent the next 3 months in the hosptial under Dr. Moosa's care. For the first month, she only recieved tuberculosis medicines and IV hydration for when her diarrhea got out of hand. Once she was a little more stable, Dr. Moosa started her on antiretroviral therapy. She also went once a week to an opthomology clinic to have her eyeball injected with antiviral medicine.

We tried to visit Lindiwe when we could but I imagine her time in the hospital was not a lot of fun. There is not much to do in the hospital and for most of her time, she was too weak to walk around. Her family came to visit, but couldnt always afford the trip into Durban. During the stay, her youngest child died of AIDS related illnesses in the pediatric ward a few stories below her floor. Needless to say this was a devastating blow to her, though somewhat expected.

Around mid-January, Lindiwe was released from the hospital and sent home with a month of antiretroviral medicine. She also had an appointment at the HIV clinic that will be managing her medicines.

I bring up this story not as some amazing success story or powerful intervention. I just think Lindiwe is an example of a tremendous problem in South Africa: the late stage AIDS patient. Her inability to access the medicines she needs to live is a recurring theme for these types of patients. I am certainly glad she is feeling better and on antiretrovirals, but I also know that she is not out of the woods yet. It will take a long time for her immune system to recover from its severly depleted state. But she at least has a much better chance of survival now that she is stable, tolerating foods, and taking her medicines.

Lindiwe is the exact type patient that I am trying to study right now. I am following a cohort of 50 very sick AIDS patients on antiretrovirals at our clinic. They are a really unstable group. 10 of them died in the first 10 months. I know a lot about the lab values and demographics, but dont know very many of them personally. So I am grateful to have known Lindiwe. To me, she is the living example of what so many South Africans go through, but with a positive outcome.

I have Lindiwe's cell phone number and will continue to follow up on her. Would be curious to see how she is doing in a few months once the antiretrovirals have had a chance to work. Hopefully, she'll have gained lots of weight, kicked her TB infection, and will have the energy and drive to raise her remaining child.

Florida Road

2006-02-24T17:32:00.000+02:00

Florida Road is the greatest street in Durban. Its within walking distance from our house, so we frequent it often to meet friends for drinks, dinner, to rent a movie or just go for a walk. A few weeks ago, Kylie and I decided to have a "progressive" evening and moved from place to place, having a drink, appetizer, or meal at each spot. Here is the pictorial journey down Florida Rd.

First stop was Zeta Bar, a very cool place with great decor and excellent drinks. It has the style of a very trendy club, but seems to attract very down to earth, unassuming clientele. We each had a mixed drink that was consumed way to fast.Next door was a new restaurant called Villa Nova. We had this crazy appetizer that was almost too good looking to eat. We really wanted to just stay and eat dinner here. We were the only people in the restaurant, and our waitress was cool. But in the spirit of our evening, we felt the need to move on. As a compromise, we decided to have another glass of wine.

We then went for dinner at Europa where we forgot to take a picture. Dont worry, you didnt miss much. Nothing too exciting, just some pasta and more wine. At this point, we were starting to get full on drinks and food. So, we decided to move on to coffee, albeit, Irish coffee.Up next was Tribeca. This is a very stylish, very aesthetic little coffee shop that has only been in Durban about as long as we have. They have one of the most creatively designed menus I have ever had the pleasure of ordering from. The whole place is decorated with a simplistic, modern style. As you can guess, everything is also expensive (at least by South African standards, reasonable cheap by American). You can barely make out Kylie sitting all by her lonesome while I took this picture. We finished the night off at an old favorite, Johnny Foxes. At this point, it was way past our normal bedtime of 9:00 pm, and the drinks, wine, and Irish coffee were having their way with our sensibilities. We managed to finish our beers, and finally decided it was time for bed.

What did we learn from our progressive evening? First, Florida road is great. Second, dont confuse a progressive dinner with a pub crawl as we somehow did. Third, we are really lucky to live in such a great, safe part of Durban. Fourth, you would have had SO much fun had you actually decided to come visit (you know who you are...)

Earthquake in Mozambique

2006-02-23T09:44:00.000+02:00

There was apparently an earthquake late last night around 12:15 am in Mozambique. It was a 7.5 and at least currently, there are no reports of serious damage. People reported feeling the quake in Durban, but if I was dead asleep. While I am a little disapointed, I suppose its a good thing. I'd rather sleep through a quake than wake up trapped by collapsed rubble. Still, this is like the 4th earthquake I have slept through. I do think it would be cool to feel one and watch it knock a few books off your shelf.

My dad is one of those types that reads or remembers dangerous events in the news and assumes that one is going to happen to me or my brother. Yet, he seems to overlook real dnagers like car accidents. When West Nile was all the rage, he harassed me about mosquitos in Galveston. Because of the 2004 Tsunami, he has been constantly worried about me getting swept away while surfing in Durban. I (incorrectly) told him that there was no seismologic activity near Durban. But apparently, the East African Rift System stretches at least as far south as the Mozambique channel. While this isnt exactly a dangerous place for earthquakes, I suppose I must now consider a tsunami generated by a quake in the Mozambique channel as a real possibility. Sometimes, those dads are actually right about a few things.

New Stuff!

2006-02-22T19:47:00.000+02:00

There is lots of new stuff on the side bar. But you'll have to scroll down and see it. I am particularly proud of the unpossible button that I stole from the South African National Parks.

Oh, and Kylie says hi to all her friends. She is doing great.

Swoptov

2006-02-21T17:24:00.000+02:00

There is something about moving to and living in a semi-exotic location like South Africa that really makes people want to say they will come visit you. Notice I use the words say they will rather than actually visit. I can (and will) name several individuals who expressed interest, or even outright stated that they were going to visit me in South Africa. Kylie and I discussed this phenomenon, and decided that it needs a name.

We thought about the term "traker" as a combo of travel and faker. Also entertained things like "traveliar." But in the middle of a very boring lecture on the history of epidemiology, I came up with the word swoptov. Its actually an acromnym for "Someone Who Only Promises To Visit." Examples of usage are below:

"Jason really seemed excited to come visit me in April, but then he bailed just before he bought his tickets. What a swoptov!"

"Erica promised me she was going to come stay with us in December, turns out she was really just a swoptov."

Can also be used as a verb:

"David always said he wanted to come see me in Peru. But then he swoptoved his way out of it"

My own personal list of swoptovs is below:

Todd Wiseman (my brother who rarely even returns my emails)
Kristi Wiseman (who graciously stayed behind so my dad could come)
Brent Savoie (former South African travel partner busy with weddings and law school)
Chad Crim (you have a child for Christ's sake, why would you even get my hopes up!)
Jesse Holmes (motivational issues were difficult to overcome)
Blake Brickman (was my leading candidate for a while, but understandably opted for a wedding)

So who is actually coming to visit me? One person: my Dad. We have a 10 day trip planned through the Kruger and to Victoria Falls. This makes him the only pwptovad that I know.

My 10,000th Day

2006-02-20T15:02:00.000+02:00

So I discovered this great new website that allows you to calculate the amount of time that has lapsed between to dates. I originally used it to find out how long patients in my study had been on treatment. Was very helpful, especially when the alternative is counting by hand the number of days between Septemebr 5, 2004 and April 8 2005. But, I also discovered that the same site can calculate your "alternative birthdays." Ever wanted to know when you will have lived for 15 million minutes? Here is your chance.

My next big date is my 10,000 day on earth. Quite a feat, I believe. On April 1st, 2006, I will have been alive for 27 years, 4 months, and 18 days. Which any calculator can tell you is equal to 10,000 days. Now that you know, I expect cards, presents, and even cake if you are here in Durban. Sure, you managed to forget my 27th birthday, but I will truly be insulted if I dont hear from you on my 10,000th day. Dont worry, you'll likely be getting another reminder.

So go on, waste some time and find out when your next big day, minute, or second will occur.

My medical indecision

2006-02-19T17:27:00.000+02:00

I had written previously about the huge question that medical students face when they are forced to pick a residency. I was only a lad of 22 when I first realized that in some regard, my career choice would fall somewhere along the greed-altruism spectrum. At one end is the Paul Farmer-esque physician who fights relentlessly for the health and well being of the poor and the underserved. On the other end is the Beverly Hills plastic surgeon whose practice is largely economically driven and makes millions off of people's personal insecurities.

I have pondered endlessly on this topic. A huge part of me wants to specialize in something. I always envied the cool, collected surgical specialist who provides their unique skills and focused knowledge whenever the primary care doctor requests a consult. At the same time, I am truly inspired by people like Paul Farmer whose dedication to places like Haiti are truly making a difference in the lives of the poor.

Aside from these issues, I also found myself interested in about every medical specialty I tried. From family practice to radiology to medicine to plastic surgery, at one time, I entertained the idea of chosing most any medical field as my career (with the obvious exception of Ob/Gyn, the worst job on the planet).

But, after all this, I think I am down to something that might resemble a decision. Sort of. I am fairly certain that I want to work in some sort of emergency care setting. This limits me to a short list of fields. Emergency medicine, trauma surgery, and ortho trauma are really the only people who spend all their time in the ER. I have always had an interest in EM, but wonder if I would really want be an EM physician taking care of drunk teenagers at 4:30 am when I am 60 years old. Trauma surgery was a possibility, but I dont think I can subject myself to the world of general surgery. I have a healthy fear of colostomy bags and also would like to someday have a life outside of the OR.

In my twisted logic, this leaves me with two options. A five year, combined emergency medicine-internal medicine residency (aka EM-IM) and ortho trauma. EM-IM would give me a very diverse background but more importantly, would give me an easy out of the emergency room when I am too old to stay up all night. An EM-IM doc is just as comfortable in an emergency as they are on the wards or in a private clinic.

Ortho trauma would let me be a specialist, but would allow me to treat patients that acutely and desperately need orthopedic intervention. Ortho trauma surgeons assess, manage, and operate on victims of major trauma. They would set your 8 year old's broken arm but also spend 10 hours in the OR repairing a trauma patients shattered pelvis. I think being a specialist like this would help me get past the whole depending on consult problem I see with fields like medicine or pediatrics.

In a sense, I am down to the same argument as before, whether I want to know a little about a wide variety of topics or know a lot about one topic. But for the first time I have some direction and some idea of where I might end up in 5-6 years.

More importantly, this small step toward a decision has allowed me to think about how I would set up my 4th year rotations. Currently, I am planning on doing away rotations in EM and ortho trauma early on to help me make up my mind.

Well, thats where I am. Would appreciate any comments!

Big day

2006-02-19T16:44:00.000+02:00

Every once in a while, I notice real improvement in my surfing. Trust me when I say this with a lot of humility. I have been thoroughly embarassed several times in the water here in Durban. Its bad enough to lost your balance and crash head first into a wave while a group of young girls giggle at you. But the most awful moments occur when you unintentionally drop in on someone (i.e. cut them off and/or steal their wave) and they make the point of telling you what a dumbass you are. This is even worse when they are 11 and you are 27. Needless to say, I went through this a lot as I was first starting, probably more often than I would like to admit. Its truly humiliating, but one of the unfortunate consequences of learning to surf in your 20's.

But on one early morning in February, I surfed like I had never surfed before. The conditions were calm and glass with 4-6 foot waves rolling through the piers (see the aerial photo taken from the Surf Conditions website on February 6). I found a spot where they were breaking consistently and kept paddling over to it to wait for a good wave to come through. I got several good rights (which means you move to the left if you are standing on the beach watching the surfer) and rode them out until I reached the shoulder. A couple nearly broke on top of me, but I managed to barely escape and turn the corner back behind the wave. As I paddled back, two guys said "Nice wave." For the first time in my short surfing career, people were actually congratulating me instead of threatening me like they usually did.

At one point, I did have a pretty nasty wipeout that dragged me toward the beach for a few meters. As I was paddling back to my spot, I made eye contact with an older surfer who looked to be in his 40's. "You've had a lot of bombs today, you should be embarassed!" he said to me with a strange smile. Oh no, I thought. Just as I thought I was getting better, this guy has to comment on my awful wipeouts and make remind me that I still totally suck.

I was a little defensive at first, and replied with some remark of disregard. Oddly, he seemed to be smiling when he made this insulting comment. I kept surfing, though with a bit more caution and certainly a lot less bravado. The more I thought about it, the more I was confused by what this guy had said to me. Why was he smiling when he insulted me so? In all honesty, I am not too caught up on my South African surfer lingo, and didnt really know what he meant by "bombs." I just assumed he meant my awful wipe outs.

So I refered to my Surfikan Slang Dictionary and loked up the term "Bomb." As it turns out, a bomb is a good or choice wave. This guy was complimenting me, saying I had caught several good waves. I suppose he said I should be embarassed because I wasnt sharing? Dont really know.

In a matter of seconds, my ego was restored and I was pleased. I found it funny that my poor knowledge of surfing slang resulted in such miscommunication. Regardless, I was happy to have made some modest improvement in my surfing and to have had some positive feedback for a change. So beware giggling girls and 11 year old punks, I have finally earned a shred of respect from my fellow North Beach surfers. Though, I think we all know I have a long way to go before I can brag with any sincerity.

Our new Jetta

2006-02-19T16:18:00.000+02:00

We sold our old, brokedown Ford Sapphire the day we left to go home for Christmas. Thus, upon returning to South Africa, we had no wheels. Luckily we found this 1996 VW Jetta for a reasonable price. This car has been a pleasure to drive. It has power steering, an alarm, gets good gas mileage, and you can acutally use the AC while driving up hills! (This was not the case with the previous car.) More importantly, she has proven reliable thus far (knock on wood). Note the totally dope surf rack that has gotten a lot of use lately!

When you show up in a foreign country for a few months and need to buy a car, one would think that it makes sense to buy a cheap piece of crap since you'll only use it for a short while. THIS IS NOT THE CASE! Buy a good car that is reliable and safe. You dont need a Porche or a Land Rover (though that would be cool...) but pay whatever you must pay to have a car that won't break down to often. That is the lesson we learned the hard way.

Paris

2006-02-19T15:59:00.000+02:00

Kylie and I had a mere 12 hours in Paris on the way back to South Africa. But it was enough for me to remember what an amazing place it is. We were exhausted and decided to splurge on a nice hotel called Hotel Bourg Tibourg in Marais. It was not cheap, but the hotel was truly amazing. Plus it was so worth it, if nothing else, to take a nap in a comfortable bed. Here is some experimental photography we tried just before heading out for the evening.

I'm Back...

2006-02-18T20:10:00.000+02:00

Have been quite busy lately, but am back and will be posting everyday now. Lots too to write about, but we'll get to it all tomorrow. Just a heads up that we're back and ready to start posting again. Check back tomorrow and there should be a lot of new changes.

Temporarily out of service

2006-01-22T21:10:00.000+02:00

I am working on revamping this site and perhaps moving it. Also writing some things, and just not posting. Will send out an email when I am back and posting regularly. Have lots to report about and lots to talk about. Shouldnt be more than a few days or so. Check back at the end of the week if you havent heard from me by then.

Cully

Tomorrow

2006-01-10T10:04:00.000+02:00

Tomorrow, I start the long journey back to Durban. I'll meet Kylie at DFW and we'll fly to New York. Then off to Paris where we'll luckily have a 12 hour layover. If we arent too exhausted, we are going to try and see some of the city and hopefully still make the flight to Johannesburg. The flight from Paris to Jo'burg is a rough one. Then a few more hours in the capital before the flight to Durban. Luckily, our good friend Susan will be at the airport to pick us up and we'll stumble into bed with the imprint of the airplane pillow still fresh on our sleepy faces.

Luckily, once we arrive, things will get much easier.

(insert sarcasm here)

In the next 5 months I have to turn poorly kept data into a brilliant honor's thesis and abstract. Plus, I have to plan my 4th year of medical school, my away rotations mixed in with all those pesky upcoming weddings. Did I mention I have yet to study for and take my second board exam? Well, throw that in the mix as well, in addition to deciding what the hell I am going to do for the rest of my life (no, I have not made up my mind yet). Oh, I forgot to add that we HAVE NO CAR. Yep, we sold our old piece of crap and will be wheel-less until we buy a new one. How will we travel to even go purchase another car? Well, I am not quite sure of that one yet. So, there is a lot waiting for me back on the dark continent. Not to mention my desire to keep surfing and not drown, and that big trip to Mauritius I have always wanted to take. To put it euphamistically, its going to be a "full" next several months.

So, while Kylie and I will have a lot on our plate, it could be a lot worse. Part of me is glad to go back to it all, despite my concerns. Besides, if I stay here, I would only have mexican food to write about on this blog. So its good for you too that I am going back. See you in a few days...

Dallas-Fort Worth Fajitas

2006-01-08T04:07:00.000+02:00

After my careful consideration of the DFW Mexican food scene, I have determined what I consider to be the best fajitas in town. I visited the top 3 Mexican food restauraunts, and ordred fajitas every time. Below are my results:

Mi Cocina: 5/10 - I was terribly disapointed by these fajitas. They were tough, greasy, and covered in a very unsatisfactory cilantro-lime salsa. The only saving grace was the cheese and the very strong margaritas.

Papacitos: 8/10 - I once considered them to be the best in town, but they were certainly less than idea. Still very good, but not exactly that great fajita taste I had so grown to love.

Uncle Julio's: 10/10 - Amazing. Best fajitas in town, period. Very tender beef, perfectly grilled with copius amounts of sour cream, cheese, and perfectly grilled flour tortillas. The new champion in my book.

Can anyone tell that I really need to get back to Africa soon to start doing some real work again?

Is it me, or is it hot in here?

2006-01-07T00:14:00.000+02:00

Since I have been back in Texas, it has been unseasonably warm. It has not rained once, has really not even been cloudy, and we have had several days of highs in the 80's. I have been out mountain biking several times, and have gone in shorts and a sleeveless shirt each time. Its the first time I have worn flip flops throughout the Christmas vacation.

So while I am certainly enjoying the mild winter, I worry a little about what this means. I have been noting warmer winters in Texas anecdotally for years now, but this one tops them all. We have even had to turn on our AC a few times. Its JANUARY by the way.

First, the warmer weather creates a breeding ground for Atlantic hurricanes. 2005 has already brought us the most active hurricane season to date. Events like Rita and Katrina were obvious signs that this was a dangerous year for storms, but many people dont realize that tropical storms continued to form well into December, and even January. Thats right, tropcial storm Zeta was named on December 30th and is still going into 2006. Its the first storm ever to span to different years.

I have some serious concerns about what we are doing to our planet, and whether we are beginning to experience some of the early effects of global warming. As a child, I remember it often snowing on Christmas in Texas. I cant help but wonder if in the future, that will simply be unheard up in Fort Worth.

So for now, I'll soak up the warm air for few more days before I head back to South Africa, where its supposed to be summertime (and its HOT down there now). But I enjoy this weather with guarded enthusiasm and hope we can find a way to solve this energy problem before its too late.

USC vs UT

2006-01-06T23:54:00.000+02:00

The UT USC game on January 4th was likely the best college football game. Ever. When have 2 Heisman trophy winners played on the same side of the football, but were totally outshined by an opponent? I havent gotten to watch much college football the past few months. Beleive it or not, they dont cover it much in Durban. But watching this game with some good friends and cold beers made up for it. Sure, I might not be so excited about it had UT lost. But it was Vince Young's flawless performance and unyielding determination under pressure that made the game so fun to watch.

However, the excitment over UT's victory was not shared by all members of the Wiseman household. My dad, a former TCU football player, hates Texas with a passion. He lost to them for years and thinks they are crooked and evil. I say put those sentiments aside when you essentially pit the state of Texas vs the state of California against one another. Pride in the great state of Texas should trump old college rivalry in my book, but hey, dads are weird.

My brother, a USC senior about to graduate, was obviously pulling for the Trojans. However, He also was not all that enthusiastic of a supporter. This is coming from the guy who lived within walking distance to the USC field, had the opportunity for a season of student tickets, and maybe has gone to 2 games in his 4 years at USC. So while he was mildly disapointing, I think he was likely the least affected USC student currently enrolled at the school.

As for me, I tend to root for the underdogs. Especially when those underdogs are the Longhorns and the favorite is a cocky USC team. Its kind of like good versus evil to me. You always root for the good guys. I did, and for once, I was right.

My trip to the Creation Evidence Museum

2005-12-31T19:28:00.000+02:00

I have been making the drive out to Dinosaur Valley State Park in Glen Rose to do some mountaint biking. The place is famous for its giant dinosaur tracks, but it also has an extensive mountain bike trail system and has some of the best trails in Texas.

About 2 minutes away from the park, is the Creation Evidence Museum. I passed it, and immediately turned around to go have a look. What I found inside must be one of the most preposterous examples of pseudoscience in Texas.

The museum clings strongly to the notion that the earth was created in only 6 days and is no more than 6,000 years old. I watched a video by the museum's director, Dr. Carl Edward Baugh. He described how God first created something out of nothing when he created the heavens and the earth. He stated that only an omnipotent and all knowing being could perform such a feat. This actually made some sort of sense to me. It was about the only thing that did.

He then went on to explain that all the land and earth that is present today is was formed immediately. He cited evidence of this by mentioning some unstable radioactive isotope with a very short half life. He failed to explain why this isotope supported the immediate appearance of land in any way. He seemed to just be using scientific terms that lay people wont understand, and likely wont question.

As the presentation went on, the claims grew more and more ridiculous. By far, the most preposterous claim was that Noah's flood did indeed occur. He explained that Noah somehow collected ALL the creatures of the earth, and put them on an arc to survive the flood. As you might imagine, this would be completely and totally impossible. Apparently, the flood also had some major effects on the earth's atmosphere. There was apparently a crystaline barrier that surrounded the earth pre-flood that helped retain electromagnetic energy from the sun. This somehow allowed for humans to grow to very large sizes. I dont understand how this factors into their theory at all, but I was stunned that they even made this claim. They attempted to support this claim scientifically by building a "Hyperbaric Biosphere" that was meant to simulate the earth's environment pre-flood. They then claimed that this atmosphere supposedly detoxified snake venom and had some very poor evidence backing this claim.

At this point, I was completely shocked. I could not believe that people actually believed wholeheartedly in science that was so clearly fallable. It seemed to even stray from the wholesomeness of the Bible, and into something akin to witchcraft. I wanted to ask the people in the room next to me if they could believe this crap. But they seemed to swallow it whole, and shook their heads in agreement everytime Dr. Baugh made another claim. After the video tour, I took some pictures, and decided the place was entirely to creepy for me. Luckily, I made it out of there unbrainwashed.

Despite complete lack of any scientific or even rational thinking in this museum, I do understand why it exists. Christianity was born in a time when we knew very little about our natural world. Indeed, dinosaurs had not been discovered, they had no concept of the atom, of biology, evolution, much less something like relativity or quantum mechanics. Just as clear evidence to the contrary squashed the theology of the greek gods (Zeus, Apollo, etc), the theory of evolution is in a dangerous position to completely debunk the theory of creation. Then we may begin to question the validity of Christianity itself. How can we believe in only some parts of God's word? This would leave millions of people with the notion that perhaps there is no God, and that there isnt some all knowing being that loves and cares for them uncondiotionally. Thats a pretty disheartening idea to get used to for many. So, I see why there exists this small and allbeit ridiculous movement to combat evolutionary theory with creationism. Sometimes I wish I hadnt ever discovered evolution so that I could still believe wholeheartedly in the Bible. It was a nice, comforting feeling to have complete confidence in your fate after death.

Anyway, I could write and talk about this topic for hours, and have many times. But, I just wanted to share this brief experience with anyone who is willing to read.

eMule

2005-12-31T06:08:00.000+02:00

So everyone got an iPod for Christmas and they have suddenly been introduced to the world of downloading music. Perhaps you have been augmenting your digital music collection since the days of Napster, or just began paying 99 cents per song on iTunes. Either way, I thought I would publicly incriminate myself and share with the world how I have been gathering mp3's for the past few years.

The big secret is a program called eMule. Its a totally free shareware program that is great for downloading most anything you can think of. I use it primarily to download entire albums of music. But you can also access great programs and software that is typically overpriced in any computer store. It takes a small amount of computer savvy to get it to working for you properly, but most people who know just a little about computers can probably handle it.

eMule can be downloaded here, just click on the installer, pick a mirror, download the program to your desktop, and run it. Follow their directions and you can be downloading music in no time.

The great thing about eMule is that unlike Napster or other fire sharing software, you can interrupt a download. You essentially download little bits and pieces of a file from many different people. If you download a large file, you may get pieces of it from different computers all over the world. It typically takes a day or two to download a whole album, but its really nice to have albums in their entirity.

eMule also likely has a lot of files and music that iTunes does not have. I've found some amazing bootlegs, recordings of concerts, and even discovered new artists and albums with it.

You'll probably also need a decrompression program to access some of the goods. Many of the files (especially whole albums) come in .zip's or .rar's. Most Windows users can access .zip's, but cannot open .rar's. There are dozens of programs, but I use Unzip them all. Its also pretty user friendly. Once you get eMule up and running, I also reccommend only searching archives if you want to download albums (just change the Type of file you are searching for under the search bar).

Finally, I should say that I know stealing music is wrong. I am a pretty ethical guy, except when it comes to this. But its just so damn easy, convenient, and cheap. Despite the admission that I am essentially committing a crime, I will likely keep downloading music as long as I can. At least until I make enough money to buy CD's in an actual store.

Feel free to contact me with any questions. That is of course, unless you work for the FBI or the FCC, in which case, this is all a joke and simply a poorly executed publicity stunt. I dont really even know what an mp3 is.

Old Friends

2005-12-27T07:32:00.000+02:00

Have been spending a lot of time with my old high school friends since I have been home. I feel very lucky to have such close friends from high school that I am still in good contact with. A few of my best friends date back to kindergarten, even birth in one case. They are a fascinating group of guys, and I truly think we are at our best when we are all together.

We recently were talking about the best concerts we had been to. We all had stories, but one of my friends told us one that topped them all. He was the musician in the group, and I was curious to know what his best musical experience was. He told us about a time that he opened for Buddy Guy at Caravan of Dreams in Fort Worth. He played drums with another friend, just the two of them playing the blues. Just two guys on stage: an acoustic guitar, a mic, and a basic drum set up. They played in front of a sold out crowd. Then they met Buddy Guy just before he went on stage to play an amazing concert. It was such a cool story that I felt the need to share it with whoever happen to be reading.

Anyway, I hope everyone else is having as much fun sharing Christmas with family and old friends.

Merry Christmas!

2005-12-25T06:04:00.000+02:00

Things you learn from uncles...

2005-12-24T05:53:00.000+02:00

Apparently "heavier" wines like a cabernet sauvignon and a malbec are best let to age for 5-10 years before drinking. I gave my aunt and uncle a South African cabernet from 2000 and my uncle told me it would be best when I finish residency. At the rate I am going, they may no longer be around by the time I finish residency. Though, I hope for their sake, and mine, that they are. Anyway, lighter wines like a pinot noir and a shiraz do not need to be aged as long. The things you learn from uncles over Christmas.

NYE

2005-12-23T06:24:00.000+02:00

This looks to me like the lamest New Year's Eve party imaginable. I hate Dallas. I can't even imagine the people who get pumped about a party like this.

Via New York

2005-12-21T23:47:00.000+02:00

It was a LONG journey back home, but I have finally made it back to Fort Worth. Flew from Durban to Johannesburg to Paris to New York to Fort Worth. Slept the whole way to Paris, watched 3 movies on the way to New York (Wedding Crashers, Charlie and the Chocolate Factory, Crash). Stayed with my good friend, Matt O'brien in NYC.

The transit strike was kind of a huge pain in the arse. Cost $60-70 to get between JFK and Manhattan. We almost couldnt find a cab willing to take us out of the city to JFK and ALL the car services were booked. Ended up spending lots of cash on taxis, but made it out of the city with time to spare. As annoying as it was for me, I am sure this strike is a HUGE problem for almost all New Yorkers. People walking to work in cold, cold weather, awful traffic, and million dollar fines for the transit authority. Big problem, but one we dont really have to worry 'bout hur in TEXAS.

Well, I actually have lots more to write about, Africa-related and otherwise. Am planning posting a lot over the next few weeks. Regardless, its great to be home for Christmas.

Sale Kahle

2005-12-19T14:06:00.000+02:00

We are heading home for Christmas. Will keep posting while I am home, but not likely to hear much from me while I am in the air between here, Paris, New York, Fort Worth, etc.

Schwarzenegger's statement

2005-12-17T18:09:00.000+02:00

Below is an excerpt from Govenor Scwarzenagger's statement denying Stanley "Tookie" Williams clemency. If you haven't read the whole thing, I would recommend doing so.

"The dedication of Williams' book "Life in Prison" casts significant doubt on his personal redemption. This book was published in 1998, several years after Williams' claimed redemptive experience. Specifically, the book is dedicated to 'Nelson Mandela, Angela Davis, Malcolm X, Assata Shakur, Geronimo Ji Jaga Pratt, Ramona Africa, John Africa, Leonard Peltier, Dhoruba Al-Mujahid, George Jackson, Mumia Abu-Jamal, and the countless other men, women, and youths who have to endure the hellish oppression of living behind bars.' The mix of individuals on this list is curious. Most have violent pasts and some have been convicted of committing heinous murders, including the killing of law enforcement."

In case you havent read all of Schwarzenegger's statement, you should know that the dedication of his book is not at all the only reason he decided to proceed with the execution. That being said, this comment has obviously stirred up some controversy over here in South Africa.

This particular comment had South Africans accusing Schwarzenegger of calling Mandela a terrorist. I find this interesting, because really, he was a terrorist. The definition of a terrorist is one that participates in the "unlawful use or threatened use of force or violence by a person or an organized group against people or property with the intention of intimidating or coercing societies or governments, often for ideological or political reasons." Now, dont get me wrong, I love Mandela as much as anyone. I believe that his efforts to end apartheid, both violent and non-violent, are to be celbrated. But no one can deny that he was a terrorist.

Now, was Schwarzenegger wrong for claiming that Williams had not reformed because he dedicated his book to people like Malcom X or Mandela? Probably so. However, I see his point on the inclusion of George Jackson.

Still, I think its more apalling that Williams seems to associate himself with these historical figures because they have both served time behind bars. Lets not forget that Williams killed 4 innocent people, essentially for fun. He murdered an entire family, and then made jokes about it afterwards. Sure, Mandela's actions may have resulted in death, but his actions were more than justified at the time.

Whether you believe in the death penalty or not, conclusive evidence has shown that Williams murdered 4 people in cold blood, and never even apologized for his actions. He was tried fairly, and sentanced to death. Its hard for me to say, but I dont think I would have granted Williams clemency either. Am I becoming more conservative?

The day they vowed reconcilliation

2005-12-16T22:32:00.001+02:00

So today is a national holiday in South Africa. I spent a few hours doing some work at CAPRISA and the place was totally empty. Everyone was off but me. Offcially, today is called "Day of Reconcilliation," though this is not the original title...

So way back in 1838, the Afrikaner settlers headed out into the wilderness of South Africa in search of supposedly unoccupied land. The Afrikaners were originally of Dutch descent and were a rather close knit bunch of folks who liked to travel in covered wagons. They were big into farming, voertrekking, and God. As they headed east across what is now KwaZulu-Natal, they encountered some angry Zulus. Back then, the Zulus and the Afrikaners didnt get along too well. And well, they dont really get along very well today.

Anyway, on December 16, 1938, about 400 Afrikaners found themselves surrounded by over 10,000 Zulus armed with spears and a bad temper. Things weren't looking too good for the heavily outnumbered white folks. So they looked to God for divine intervention. They made a pact that if they survived this day, they would build a church and commemorate the day for years to come.

While the Afrikaners were heavily outnumbered, they did have plenty of rifles and a whole lot of bullets. Tragically, over 3,000 Zulus died this day. Their spears and ferocious warfare were no match for the Afrikaner rifles. Not one Afrikaner lost their life and the battle was known as the Battle of Blood River. December 16 was remembered each year as "Day of the Vow."

This day was celebrated as such until the end of apartheid in 1994. Once the new government took over, they changed the name to Day of Reconciliation in an effort to foster peace and understanding between the two groups. Many of the Afrikaners were not too happy about this change, but have since conceeded to the more politically correct name.

I can kind of see both sides to this. Afrikaners are very proud of their heritage and the Day of the Vow is an important, if gruesome day in their history. I imagine they believed God got them out of that mess, and that they should pay homage. However, its doesnt exactly unify a multiracial country when you celebrate annually the slaughter of one ethnic group by another. Just one of the many, many confusing, conflicting dillemmas that make up South Africa's diverse past.

To be honest, I dont think many South Africans really considered all this historical tension very much. I think they were too busy making the most of a long weekend. They beaches were absolutely packed. I checked the surf report today to find this picture of one of my favorite surf spots completely taken over by beach goers. I have never seen the beaches like this.

So what did this day mean for me? Not much. I celebrated by coming home from work early, sitting on my comfortable purple couch and watching the movie Willow while sipping cold apple juice. It was actually quite nice, though Willow is really not as excellent a movie as you might recall.

Regardless, Happy day of reconcilliation from South Africa!

Lindiwe

2005-12-15T12:17:00.000+02:00

About a month ago, one of the HIV counselors at the clinic asked me to see a patient he had been talking with. The patient had just tested positive for HIV, and had come to our clinic with her mother because she heard we could treat AIDS.

I walked in the room to see a young, frail girl sitting in a wheelchair. She looked very weak and tired. A colorful Zulu blanket covered her legs. Her limbs were so emaciated and thin, you wondered how she moved her arms without breaking them. She could not stand and was barely able to hold her head up. Even her tears were meager, small streams of saline trickling down the saddened contours of a sunken face.

Lindiwe Zama* was 25 years old and had been struggling with full blown AIDS since the birth of her second child several months ago. Her illness began with mild headaches that gradually worsened into overwhelming migraines that eventually kept her in bed most of the day. After weeks of unrelenting pain, she and her mother went to King Edward Hospital (the teaching hospital here at the medical school). Her headaches were easily explained by a tuberculosis infection that had been growing in the fluid that surrounded her brain. A CT scan and a spinal tap confirmed the diagnosis. TB meningitis was a clear indicator that she had AIDS and needed antiretroviral (ARV) therapy. For reasons I don’t understand, she was not started on ARV's at this time.

She was started on the 6 months of TB therapy needed to cure her very dangerous infection. After a month of therapy in the hospital, she was sent home to continue the medications. After a few weeks of being at home, she began to develop severe nausea, and diarrhea. She dealt daily with excruciating stomach cramps, vomiting, and incapacitating weakness. In this time, she lost about 25 lbs off her already thin frame. She could not keep down any food, and thus, could no longer take the daily medication she had been prescribed for her meningitis.

Over the next few months, Lindiwe became so dehydrated that he was brought into a local hospital to receive IV re-hydration. She would show up to Addington Hospital (a local hospital that I wouldnt send my worst enemy to) much too weak to answer questions. They would start an IV on her, get her stabilized, and send her right back home again. For several weeks, she bounced back and forth between her home and various Durban hospitals. Its amazing she survivded all this. She and her mother had no idea know what to do. Every time she came back from the hospital, she would get sick again, and need to go right back. Somewhere along the way, she also picked up a dangerous viral eye infection that blinded her in one eye (CMV retinitis to all you medical students). As if that wasn’t enough, her newborn child had contracted HIV from Lindiwe at birth, and was now involved in his own fight to stay alive. Currently, the baby has advanced AIDS and TB, and will likely not live beyond the age of 2.

Lindiwe lives in a 3 bedroom house with 6 adults and 7 children (aged 5 months to 11 years). She lives in a township called Folweni. A township is essentially a large, very densely populated urban area where only black South Africans live. Most whites, including myself, will not even drive through one alone. This family lives off of about $120 a month, all coming from the grandmother’s pension check. None are currently employed. Lindiwe previously worked at a factory where she earned some money, but she was forced to quit when she had her second child and the headaches began. The father of her children works as a mechanic, but does not help financially with the children. He is likely the one who gave HIV to Lindiwe and her daughter, but has not been tested himself.

As I sat and listened to Lindiwe’s story, I knew she would soon die if something wasn’t done for her quickly. She was receiving occasional supportive care from local hospitals, but no one was starting her on the antiretrovirals she needed to get her healthy again. I also knew that no one would. Lindiwe was much too ill to start ARVs in our outpatient clinic. At this stage of AIDS, ARV’s can kill a patient if they are not managed daily by a skilled clinician. Besides that, I knew she might die from dehydration and malnutrition before she could even be started on therapy.

Lindiwe needed careful management by a skilled AIDS clinician. I only knew of one such clinician in Durban. Dr. Yunis Moosa, a doctor I had written about previously, was the only one I believed had the knowledge to help her. With the help of another clinician, we called the very busy doctor who happily agreed to see Lindiwe. Within a day or so, she was admitted to King Edward Hospital, and was being followed by the infectious disease team. I knew Lindiwe didn’t have a very good chance of seeing her 26th birthday. But I also knew Dr. Moosa was about the only clinician in Durban that would at least give her that chance.

For the past month, Lindiwe has sat in a hospital bed on the 5th floor of King Edward Hospital. Everyday, Dr. Moosa and his team have rounded on her. She is being treated for the TB that has now spread to her abdomen and is receiving weekly injections into her eye for the viral infection that she acquired. She inevitably has bouts of diarrhea and dehydration, for which she receives IV fluids until she feels better. She recives three meals and is on several multivitamins.

Today, she starts antiretroviral therapy in a safe controlled environment. However, I write this with guarded optimism. Lindiwe has advanced AIDS with multiple opportunistic infections. Her CD4 count was 2 (a normal is about 1200, you start ARV’s at 200). While ARV’s are her only hope, they may also be what kill her. When you suddenly bring a patient’s immune system back to life, it can try to attack the many viruses and bacteria that have been growing there. This massive immune response has killed many patients in Lindiwe’s situation. It’s a risk, but one that must be taken.

Lindiwe is the patient that we stole the cell phone for on the bus back from Coffee Bay. We go in and visit her a few times a week, just to say hello and take a look at her chart. Because she is essentially trapped in the hospital with no TV, books, etc, we occasionally bring her magazines and books. It’s the very least we can do for someone who doesn’t deserve any of what she has experienced.

Lindiwe’s case brings up a lot of issues about HIV in Africa. From the way she was infected, to the financial situation at home, to her son that is dying of AIDS himself. It’s hard for me to understand why she was never even offered ARV’s when each hospital she attended offered them. I have no doubt that had we not fought to get her into see Dr. Moosa, she would have died without ever starting ARV’s. She may still die anyway, but at least she was given the chance of survival.

It’s hard to imagine, but Lindiwe is literally one of the millions of patients who need, but cannot access AIDS medication. She actually was lucky to be in South Africa, and even luckier to get in to see Dr. Moosa. Patients in other parts of Africa don’t even have the option of ARV therapy, and live in much worse conditions, miles from any hospital. So if I leave here with no published paper, no abstract, no honors thesis, I know I at least helped to provide one patient among millions, a small chance to someday resume a normal healthy life. Its not exactly something you can put on your resume, but people like Lindiwe kind of make things like papers and resumes seem trite and pointless.

*name was changed to maintain patient confidentiality.

Death penalty and humanity

2005-12-14T10:43:00.000+02:00

Does it seem wierd to anyone that the traditional conservative stance is to oppose abortion, oppose medically supervised suicide (i.e. desperately trying to keep brain dead Floridians alive) and generally fostering a "culture of life" as Bush puts it, yet they will execute people with little disgression? I am not asking this in an accusatory sense, it just seems contradictory. You would think that those who want to maintain this culuture of life would oppose the death penalty. Seems kind of dumb to me, but then again, I am pretty liberal. I think...

This all makes me wonder about the fundamental differences in the left and the right. Is there any central philospophy that guides either one? If so, its a loose association. What is the central ethos behind a conservative philosophy, a liberal one?

If I had an ethos, this would be it: I think there are way too many people in the world. We have overpopulated and are thoroughly destroying our planet, as well as our own sense of humanity. Because we are so populated, disease, famine and poverty, have made life miserable for millions. Thus, I am guided by the principle that we should maximize the number of happy, safe, comfortable lives that can be maintained on our planet. Currently, we are not doing a very good job. So I say, why bring unwanted children into the world? Why force people who would rather die, to live a hell on earth, and stay alive. Why waste millions of dollars on keeping prisoners alive who have raped, murdered, and cannot be reformed? Lets focus our efforts on the people that want to live peacefully within society, but cant find a job or lack basic healthcare. How many villages could have been fed on Terri Schiavo's hospital bill for the past 20 years?

Actually, I dont know if all that is true. Again, I am "trying on" an argument to see if it really holds water. Funny how most of them dont, especially if Blake is your friend. But what a better way to find out that a central philosophy is flawed than to post in on your blog for all you smart people to read and criticize!

How am I doing?

2005-12-13T11:19:00.000+02:00

I am excited to go home for a bit and see my family. Really excited to see some high school friends in Fort Worth, and hoping to see some medical school friends along the way. Will also hopefully make a trip to Dallas to see friends from college. I miss all these great people that have come into my fragmented life. Also excited about the many presents we have collected for people over the past few months.

I am terrified because I still dont know what residency to apply for. I debate everyday about staying in line with my current effort to save the world and do some aspect of medicine/international health/research, or to go out on a limb and pursue some surgical subspecialty (ortho? trauma?). I took a whole extra year off and still dont know. I am the most indecisive person alive. Will write more, perhaps much more, about this later.

I am frustrated because my job basically has been to track down missing data. CAPISA is a poorly run, disorganized nightmare of a place to work. I am constantly having to look for data that someone else has lost, forgotten about, failed to write down, etc. I havent seen any of my supposed mentors or supervisors in weeks, and most wont respond to my emails because they are too busy not helping me. This is a really, really annoying place to work and I no longer have any reservations about making this fact known to anyone who will listen.

I am encouraged by people like Dr. Watts at UTMB who have spent a lifetime doing research in the developing world, and understand how frustrating it can be.

I am thankful of the statisticians (who I have learned are the only people here that know what the hell is going on) for their help and support.

I am pumped because I had a great morning of surfing. Surfed North Beach with 3-6 foot waves in glassy, smooth water. Managed to catch waves despite the crowds and had a great left all the way in. Still working out those backhand rights.

I am confused because this patient in the hospital just wont get any better. She has days where she is happy and excited, and days where she can barely hold her head up. When I last saw her, she was considering a trip down the stairs and outside (would be her first time in weeks). But I brought her a newspaper and a magazine yesterday and she was too weak to hold them up or even read. I worry what will happen to her while I am away for Christmas.

Finally, I am happy that Kylie had a good birthday and that we have had so much fun here so far. Despite the pressure, the confusion, the frustration, we have the unique opportunity to live in another world for a year and enjoy all the amazing things around us. In ten years, hopefully I wont remember the bad things, and will instead focus on the many great things that have happened and have yet to happen.

The weekend

2005-12-13T08:17:00.000+02:00

Kylie's birthday was Sunday and we decided that since we were going home so soon, we'd stick around Durban and do some of the things we had never been able to do so far. First, we tried to go out with the Natal Shark's Board. They maintain the shark nets that keep us safe from jaws everymorning and they offer boat trips to go out and maintain the nets. We took their boat through Durban's enormous bay and out through the harbor mouth. There we encountered some pretty large, choppy waves and were forced to turn around. No sharks, but it was really cool to see the ocean so big and choppy.

We were back early, but this was a good thing as we got to have one last breakfast with our friend Nupe who was sadly heading back to the states that afternoon.

Sunday, we finally made it out to Ushaka Marine world. This is a huge new water park very near the harbor mouth. Its one of those places you really have to go to at some point while you are in Durban, no matter how much you hate crowds and parks.

I was a little reluctant to take Kylie here on her birthday. Might have worked if she were 7 years old as opposed to 27. But it turned out to be great. We rode waterslides for a few hours. We stood in line with other 7 year olds and it made us act like kids again. We did about every slide they had, and then did our favorite ones a few times. I really love waterslides, always have.
We dried off and headed across the park to the aquarium. I wasnt expecting much, but it was really amazing. A huge aquarium with ceiling to floor viewing windows. They had several sharks, some rays the size of a cow, glowing jellyfish, old sea turtles, and even a Finding Nemo tank with all the characters. We spent a long time at the aquarium staring and laughing at the fish.

We finally made it home in time for pizza and barely stayed awake to watch the Endless Summer, a classic surfing movie that even showcases some of Durban's great waves.

All in all it was a great day, and hopefully a great birthday for Kylie.

Waste some time this festive season

2005-12-10T12:14:00.000+02:00

This is a great site to make your own Snowman. Well worth it if you feel like wasting 10 - 45 minutes.

And speaking of wasting time...

Lost and found

2005-12-09T17:18:00.000+02:00

Kylie and I had gone to South Beach for an early morning surfing session. This beach is a little more timid when the surf is raging. It was a beautiful day with some nice waves. We went through the now well rehersed routine of stripping off the wetsuits, drying off, and loading up the boards. This was the morning of the big swell that struck Durban in early November, so we drove down the Marine Parade to watch the surfers and big waves.

We finally made it back to the house a few hours later. We were unloading the boards and wetsuits when we realized we had left Kylie's wetsuit at South Beach. This was a big loss as we had just bought her wetsuit only a month or two ago, and wetsuits arent exactly cheap. We had to go back and at least look, but we had a feeling the wetsuit was long gone. We had been away for about 2 hours, so we figured it was already sold to a pawn shop.

We pulled up to the beach to have a look, and sure enough, there was no wetsuit to be found. We were about to get into the car when the car park attendant hollared said "Hay Siss, you leave a swim suit and towel here. Yes, I knew dat was you..." He had found the wetsuit and hid it in one of the buildings nearbye.

I should note that car park attendants are somewhat novel to South Africa. Because of the constant threat of car theft, they watch over your car while its parked. They often poor men, just happy to have a paying job. Sometimes, their only income is the few Rands you hand them as a tip as you leave the lot.

Well, this car park attendant earned himself a hefty tip on this day. We were so happy to discover that the wetsuit hadnt been lifted. This obviously happened a few weeks ago, but I wanted to go back and right about for a few reasons. First, it was an incident that restored our faith in this city that is often notorious for its crime rate. Second, I wrote about this very beach, how a possibly drunk, very sketchy guy offered to wash our car. Finally, I thought it kind of tied into the recent post about finding the cell phone. Regardless, we were pumped to have the wetsuit, and the car park guy was also pretty excited to get a nice tip. That day, everybody won.

Lots of working, lots of surfing, less sleeping

2005-12-08T21:59:00.000+02:00

These two things have taken up most of my time the past 2 weeks. Have been working hard to get a lot of things in order for this research project before I go home. Lots and lots of frustrations, difficulties, and periods where I sit and the computer and try to think of what to do next. The good news is that I officially sent in my Honors Thesis proposal today (am going to use my research project here for a thesis) and am learning a lot about how data can be managed, sorted, and analyzed. Also just learning about how much work and effort goes into even a simple chart review. So I'm making progress, though most of the time it doesnt really feel like it.

But we've also found time to surf a lot lately. The waves have been small, but fun. Plus, there have been some beautiful mornings with calm water and sunny skies. This should all change tomorrow morning as monster swell is expcted to build over night from a powerful storm off the coast. May opt for the smaller breaks tomorrow as 10 foot waves may once again be possible in my usual surf spot. Will definately take the camera and grab some pictures if anything interesting happens.

And all this adds up to a very, very tired Cully. Its 10 pm and I can barely keep my eyes open. Time for bed!

Zuma now officially charged with rape

2005-12-08T21:48:00.000+02:00

I had written a little about Jacob Zuma, the former vice-president of South Africa and his recent endictment in relation to a bribe and a potentially corrupt arms deal. That was really bad news for Zuma, as well as the ANC, the ruling part in South Africa.

But this blows it out of the water. Just yesteday, Zuma was officially charged with raping a family friend in Johannesburg. He has now stepped down as the Vice-president of the ANC and will likely focus his efforts full time on his two pending court cases. This is an even bigger blow to Zuma and the ANC. Plus, its essentially career ending for Zuma. In combatting his corruption charges, he still had some financial support to pay for court fees, many of those supporters have now backed out once he was charged with rape.

What really gets me though, is that he is still immensly popular in South Africa. I saw a news channel here interviewing various South Africans. They seemed to support Zuma in his recent charge, and suggested they would continue to support him regardless of the out come. To me this seems ludicrous. But, then again, I stood by Clinton even as he was impeached.

Anyway, this is the major news in South Africa. I am sure the shooting of a passenger on the Jetway in Miami is making headlines in the states, but Zuma and his trial is in the center ring in South Africa.

Thanks

2005-12-08T21:44:00.000+02:00

I wanted to say thanks to people who leave comments here. Whether positive or negative, it at least lets me know that people are still interested in what I am up to and what I have to say. To be honest, I kind of slowed down the posting for a few weeks because I wondered if I was writing for an audience of one. So it was good to hear from some people recently. Keeps me motivated to write everyday. I suppose my motivation should just be to record my thoughts and document what happens here, but that seems a little egotistical eh? Regardless, its great to hear what you guys have to say and it really does keep me writing.

Long-winded moral dillemma

2005-12-07T18:21:00.000+02:00

So we were on a night bus heading back from Coffee Bay. We were a small group of only 3 umlungu's (Zulu for "white person") on a double decker Greyhound. People are getting on and off periodically and the lights go on and off at every stop. About half way through the journey, a cell phone in the seat next to us begins to ring. And not just once. Someone is calling the cell phone EVERY MINUTE. Someone had been sitting there previously, but we dont know where they went. We try to ignore the phone, but it continues to ring and ring and ring. We look for the missing passenger to tell him that his phone is left behind, but he is no where to be found. Finally, after another 20 minutes of incessant annoying cell phone noise, I get up to turn the thing off.

Now, we can sleep. We doze for the rest of the trip and none of us wake up until we are about 20 minutes outside Durban. I notice that the cell phone is still sitting on the bus seat. Then it hits me. Someone had accidentlally left their phone on the bus at one of the earlier stops. It was the owner that was apparently calling non-stop. He was hoping another passenger would pick up. It seems like an odd way to get your cell phone back as I wasnt about to answer the ringing phone. But I suppose it was the owner's only hope.

So my first thought is to turn the phone back on and simply call the number that had been calling the phone and tell the owner what had happened. But, like most phones in SA, it asks for a PIN number before switching the phone back on. Essentially, unless you replace the SIM card inside the phone (which only cost about $3), the phone is locked.

So we find oursleves faced with a moral dillema. There is a nice, fairly new Nokia cell phone sitting on the seat next to us. Its clearly been left by a passenger, but there really is no way to contact the passenger or even find out who they are. If we could, we would but there really was no way to identify this person. If we leave it on the seat, it will inevitably go into some nationwide lost cell phone box and the chances of it ever going back to the owner are slim. Likely, the bus driver or cleaning crew will simply pocket the phone as they too know it will never be returned to the owner.

So what do you do? You could leave it there, and hope for the best. Turn the phone into the bus driver. You could keep the phone, pop in your SIM card, and replace totally outdated piece of crap phone you have now. To me, these were the only options, and I was just going to leave the phone there.

Luckily though, Kylie and another girl, Kate from California, had a better idea. Grab the phone, buy a new SIM card and charger for about $10, and give the whole package to a deserving party. Perhaps a sick AIDS patient at the clinic. Kind of like a Robin Hood plan. I wanst convinced that this was the best idea, but it seemed better than leaving it for the bus driver. So I committed my first act of theft in South Africa. When no one was looking, I slid the phone into my bag. No one noticed.

It turned out to be a great idea. After making sure the phone worked and replacing the SIM card and charger, I brought the phone to one of our referred patients in the hospital. She had been stuck in the medical ward for 2 weeks with no books, magazines, or any way to contact her family. I knew she had no cell phone because I took her history and referred her. This is a girl who has been sitting on a hospital bed with diarrhea, CMV retinitis, TB throughout her abdomen, and had about a 50/50 chance of leaving the hospital alive. Yet, she seemed a very kind and honest girl, well deserving of someway to contact her family while in the hospital.

I went to visit her today, and brought her the phone. She was elated. I really thought she was going to cry right there. I was almost embarrassed. I was happy, she was happy. The only person to lose here was the poor guy who left his phone on the bus. I have to commend Kylie for thinking outside of the box on this one and coming up with a good idea.

This patient was one of the first AIDS patients I interviewed and took a thorough history on, as I mentioned I would do on this blog previously. She has a really amazing story, but is not out of the woods yet (still in the hospital and not. I will write more about her, but will be sure to link back to this post when I do.

Slacking, but not really

2005-12-06T22:49:00.000+02:00

So the blog updates have been a little sparse. I apologize. It happens to everyone. Below are some hopefully entertaining pictures and stories from a recent trip to the Eastern Cape that I hope will placate my audience for the time being.

I can say that I was slightly busy writing with my Nigerian email friend. I made up a fake email address and responded to one of those obviously fraudulent emails about some wealthy relative of mine that died with millions in the bank. There is always a greedy Nigerian at the other end trying to take some poor sap's money. I emailed a lot with someone claiming to be a "Barrister" from Nigeria, while I posed as a regular Texan willing to cooperate with the supposed lawyer. He sent me some obviously fake documents that I posted earlier. He also kept asking for my phone number. I wasnt about to give him my real number, so I looked up a Walmart in Houston and told him to call me at 8 pm (which was 2 am his time). Needless to say, he wasnt very happy when he found out my alter ego didnt really work there. We have since ceased communication.

But instead of blowing my cover and berrating him for trying to steal American's money, I asked him to please stop sending emails and damaging the name of his struggling country. I told him to use his apparent knowledge of emails to start a business or to help somone. That was the right thing to do, right? He didnt seem to think so.

I thought I was really clever until I discovered a whole cohort of folks dedicated to scamming the scammers. Their main site is www.419eater.com and its actually pretty interesting. Gets into the questionable ethics of re-scamming the poor Nigerians who have no other way of making a living except via fraudulent emails. Anyway, I could never live up to these guy's genius, so I likely wont be responding to anymore Nigerian email scams. Probably.

But to be honest, work at the clinic has taken up a lot of time and energy lately. I suppose that is fitting since that is WHY I AM HERE... Have been desperatly getting all the data together, finishing up a thesis proposal, and counting the ways in which CAPRISA is a total disaster of an organization. But that is another story....

Coffee Bay

2005-12-04T11:14:00.000+02:00

Last weekend we made the long journey to the Eastern Cape from Durban. The Eastern Cape is the province next to KwaZulu-Natal. Its considerably less devloped than the reas of South Africa. During apartheid, it was essentially a dumping ground where the government moved and forced black South Africans to live. It certainly feels different as you drive through the country side. Its a much more rural, agrarian South Africa where people really depend on the land to get them by. This type of society, which depends largely on local subsistence farming, obviously has its drawbacks when compared to a more industrialized alternative, as evidenced by recent famine in Malawi. South Africa for the most part, is much more developed than the rest of Africa. Most of its citizens have power, you can drink the tap water, and the government's efforts to improve the quality of life of its people is present on many levels. But a lot of this is lacking in the Eastern Cape. Most all of the traditional Xhosa homes (which are round, one roomed, mud walled huts with a reed thatched roof) do not have electricity. Its the only place in South Africa where its unsafe to drink the water.

But the Eastern Cape (also known as the Transkei) also has some amazing countryside, beautiful secluded beaches, and fascinating culture. And to be honest, when your job is to work among the world's most ill and destitute AIDS patients everyday, sometimes you need to get away and realize that life can be happy and fun and wonderful.

So we hopped on a bus and took the 5 hour ride to Coffee Bay. We stayed at one of the best hostels in South Africa, the Coffee Shack. This is a hostel that attracts a really great crowd. A fine mix of South Africans escaping Johannesburg, a handful American do-gooders (that is where we fit in, I suppose), the requisite crowd of rowdy Dutch guys, and even the odd Spaniard or two. The Coffee Shack was a stone's throw from the water, and a short walk to a protected bay with some nice beach break. It was paradise with lots of cool people to share it with. But the ebst thing abotu the place was the way they really worked to support the local community. They employed a lot of the local villagers and set up a charity to fund one of the schools nearby. Very respectful but fun environment.

Most nights we spent playing pool, poker (we play a lot of Texas Hold'em these days), talking, hanging out at the bar. Nights went late, often until 2 or 3 am. Then we'd crawl out of bed as early as tolerable and head over to the beach to surf. We toted the longboard and wetsuits all the way from Durban, and it was fun to catch the gentle beach break of Coffee Bay. By the afternoon, we usually needed a nap. I'll let the pictures do the rest of the talking....

This is Coffee Bay. A wide beach with some rocks in the foreground. There was a nice beach break that can be seen here, and a point break that was a little too rocky and shallow for my taste. I actually snapped a fin off at one point on a large floating log that had floated out of the river mouth. Note: surfboards work just fine with two fins (I didnt even know it was gone...)

The very small, but always accomodating bar and pool room.

Here, Kylie plays a hand of Rummy amidst 12 foot tall Amstel bottles.

I had to put this one up of our Durban friends playing card games with the National Library of Medicine cards that were given to all the Fogarty Fellows during our 2 weeks of training at the NIH (previously refered to as "nerd camp"). These are the nerdiest cards imaginable. Yet, they somehow found their way into being licked and applied to the side of this guy's face. I dont think this is what they had in mind when the NIH gave us this deck.

World AIDS Day

2005-12-01T09:25:00.000+02:00

Today is World AIDS Day. Essentially, it’s a day to promote awareness of the global pandemic. There are candlelight vigils, lots of linked hand ceremonies, and everyone is supposed to wear the red AIDS ribbon.

It seems like a great idea in theory. A whole day for the world to at least think about AIDS more often and how it is impacting humanity. I believe awareness of the situation in Africa is indeed one of the only ways we can even begin to make an impact in this epidemic. But living in South Africa, where the number of HIV positive individuals soared to over six million this year, it seems kind of futile. I think about the hospital full of sick, dying patients in the medical wards not 100 meters from where I type these words. I wonder if they even know its World AIDS Day. Its just another day of living with the disease for them.

And these are not easy days. The experience of an sick AIDS patient in the hospital is filled with symptoms like chronic diarrhea, blinding eye infections, severe abdominal pains, uncomfortable and disfiguring rashes, unrelenting nausea, powerful headaches, and fear. Constant, permeating fear that one has no control over the disease that is ravaging their body.

When you see whole hospitals full of adults and children living like this, it kind of makes the hand holding and the ribbon wearing seem trite and tragically ill equipped to make an impact. But, for someone living in Texas or California, thousands of miles from the nearest South African AIDS patient, it is at least one small way to feel they are recognizing the epidemic. And that small way, is a lot better than nothing.

So on the radio or on CNN, you are likely to hear the most recent statistics put out by UNAIDS. They just came out in November and essentially say that HIV is still spreading rampantly. The worldwide prevalence of HIV has increased from 37.5 million in 2003 to 40.5 million in 2005. More than 3 million people died of HIV in 2001, 500,000 of them were children. South Africa has more cases of HIV than any other country in the world, with 6 million infected individuals. The official report can be found here.

Its easy to hear these numbers, and gloss over the millions here million there. We get so immune to the statistics, its easy to forget how significant those numbers are. I think a good way to keep it in perspective is this:

Currently, there are over 40 million people with HIV. If the disease were to stop being spread right now (which would be a tremendous miracle). That would still leave over 40 million people. That’s essentially double the population of Texas. So lets suppose that only this many people are affected.

That is still over 40 million people that will die a drawn out, painful, horrendous death over the next 5-10 years if nothing is done. 40 million people that will eventually end up in an understaffed, poorly equipped hospital where they are likely to die from any number of opportunistic infections.

But, there is good and bad news here. The bad news is that the number is not going to stay at 40 million. It will continue to grow and spread, though no one has any idea how much that number will increase. 50 million? 60 million? We just don’t know.

The good news is that we have medicines that can keep these people out of the hospital. Antiretrovirals are really all we have to try and keep this immense number of people healthy and living the kind of life they deserve to live. I know because I work with these people everyday. Many came to our clinics barely able to walk, and are now living relatively normal lives.

Currently, of the 6.5 million people that need antiretroviral medication (not all of the 40 million have HIV that is advanced to the point that they need medicines, though they all eventually will), only 15% are receiving it. This means that over 5.5 million people will die in the next few years if they do not receive treatment. ARV’s can help, but only if they get to the people that need them most.

So, what can you do? If wearing a ribbon and holding a candle is enough, then commemorate World AIDS Day, and help promote awareness in your community about this disease. That at least is something. But if you would like to do something more substantial, then donate to the Global Fund.

The Global Fund to fight AIDS, TB, and Malaria is one of the world’s largest contributors to getting antiretroviral medications into developing countries. In my opinion, they are the most reliable, most trustworthy organization. If you are up to it, I am sure they would appreciate your donation, no matter how small. As would the millions here in South Africa that are in desperate need of treatment.

My Thanksgiving dinner

2005-11-24T22:55:00.000+02:00

This was my third Thanksgiving out of the country. Once before in New Zealand, and another in Tanzania. There always seems to be a sort of patriotic gathering that occurs amongst Americans abroad on Thanksgiving. Its a holiday totally uncelebrated by the rest of the world, so its kind of our own day that few people really understand. But the ex-pats always seem to find away to get together, and do what Americans do best on Thanksgiving: eat themselves into a stupor.

I met a group of 8 Americans at a great restauraunt called Cafe 1999. Hardly a traditional or homestyle establishment, but ended up being an excellent choice. But it was the amazing mix of people that really made it a great meal. It was one of those situations where I dont think everyone really knew everyone. We all knew someone else there, but most of us were meeting for the first time that evening.

In attendance were:

A Fullbright scholar who just graduated from University of Michigan (Anand)
A pediatric infectious disease fellow
An artist working in Zulu sculpture
A medical student from Texas doing HIV research (this one is me!)
A medical student from New York doing HIV research (Sara, a co-worker)
A beutiful nurse from Texas (her name starts with a K)
A guy who made 18th century brooms for most of his life, but started PA school at age 57
A nurse-practioner/midwife/PA
(the last two were a couple)

The broom maker and the midwife actually took the cake for the most fascinating people at the table. They were both theoretically retired, but had been working on projects all over southern Africa for the past few years. They had done everything from teaching at oprhanages about how to care for HIV infected children to work in prevention of vertical transmission of HIV from mother to child.

But was really fascinating was their "relationship." They had to have been one of the few people on the planet that managed to negotiate a functional open marriage. They each had other partners/lovers that they would see from time to time, with supposedly no jealousy. In fact, the extra partners were often close friends to them both. And usually, the extra partners had 1-2 partners of their own. Once the table discovered this, we were captivated. Questions were fired at them before they could even answer.

Essentially, it seemed that they made it work because they truly beleived they were soul mates. They knew that their spirits had been together in past lives, and that there really was no one else better for them. Sure, they had other partners that were friends, lovers. But nothing came close to the deep connection that they seemed to share. It was interesting to hear about, though not your typical Thanksgiving dinner topic of conversation.

So, all in all it was a great thanksgiving. The food was incredible, one of the best meals I have had in Durban so far. But the company was really a great mix of diverse, fascinating people. For that experience and for the many great experiences I have had already, I am quite thankful.

ID Card

2005-11-23T22:49:00.000+02:00

This is the first scanned document sent to by my Nigerian banker friend. Looks legit to me, maybe I should fork over my bank account information. Actually, what I think I will do is see how many scanned, false documents I can get him to send me.

Happy Thanksgiving

2005-11-23T22:43:00.000+02:00

It doesnt really feel like Thanksgiving at all here. Kind of strange. I wasnt even sure what day it was. As odd as it is for me, I am sure its equally strange for our families not to have us around. Anyway, Happy Thanksgiving to my friends, family, and anyone else that stops by.

Why are you beautiful?

2005-11-22T20:10:00.000+02:00

Standing at the base of the Sterkhorn on my birthday a few days ago, a question hit me that I have been thinking about a lot lately. We were staring at this amazing site. The Sterkhorn and Cathkin peak, shimmering in the early morning sun. It was truly beautiful.

And just with everything else in my life, I had to ask the question: why? Why was this scene so beautiful and pleasing to see? If you think about it, its really, really hard to come up with any answer that makes sense. We obviously tried to think of something, but didnt succeed. Perhaps you can...

First, we thought that perhaps the rarity of the scene makes it beautiful. If we were surrounded by beautiful mountains all the time, perhaps they would lose there aesthetic value. Maybe this mountain scene was beautiful because it was such a rare opportunity to see. But I dont think this postulate holds water. Many things are rare (did I just contradict myself?). For example, six fingers on one hand is exceedlingly rare. I saw it once on a Guatemalan baby. Let me tell you, it was not beautiful. Thus, rarity itself cannot equal beauty. There had to be another reason.

I argued that perhaps it was the fact that we were viewing something so vast in size and area, yet so very detailed. Indeed, you could see every little crack and crevice across an entire mountain. There was a tremendous amount of information zipping into our retinas at the speed of light, much more than when you simply look at your hand or the grass. Perhaps this was the key to beauty, at least in nature. But then I thought of a beautiful sunset or even a single moon lighting up a black sky. Not much detail there, just a sense of aesthetic satisfaction that we cant really explain.

So why do we find some things beautiful and others not? Why does the Grand Canyon awe us so when a ditch in the ground is not even noticed? While beauty is subjective, there is certainly some general gathered opinion as to what is considered beautiful and what is not. I think this question has profound implications in nature, love, and especially art. Would love to hear other's ideas while I struggle with my own.

Unbelievable

2005-11-21T20:48:00.000+02:00

I found this article that came out TODAY regarding the capture of Nigerian email scammers who bankrupted a Brazilian bank. They apparently stole $242 MILLION dollars. Quite ironic that this article was released today.

Anyway, the offenders were sentanced to a total of 37 years in prison. I cant even imagine what it would be like to spend a day in Nigerian prison, much less the rest of what would likely be a very short life. Take a look at the article if you have the time.

My first response

2005-11-21T20:18:00.000+02:00

Yesterday, when I finally didnt have anything better to do, so I made up a Yahoo email account strictly for use in my Nigerian email scam detective work (see previous post). I emailed one of the older addresses I had received, thinking that it wouldnt even work. But sure enough, the next day, I got an email from someone posing as a lawyer in Nigeria. And this one was personal, not blatantly computer generated (I know this because he made specific references to questions I had in my initial email).

I was actually pretty suprised. I wasnt exactly sure what to write to him. So, I tried to bait him by telling him how excited I was to cooperate with him and how happy I was to be emailing with such a friendly lawyer. I actually tried to sound pretty gullible. But then I requested some information, like his credentials, CV, some information on the person that supposedly died in the accident whose millions of dollars I stood to inherit. Also just some information on his home country, for my own knowledge of course. I think my goal will be to lead him along and force him to come up with as many false documents as possible. I'll start easy, but hopefully progress to things like photographs and personal references. I figure I'll give him a lot of homework and he'll be too busy to steal other people's money.

What I learned already is that these people (not suprisingly) dont keep very good records. I personally received an email about this deceased fellow, but my fictional email account obviously did not. Any respectable con-artist would realize that their fake email scam was never even sent to the address that was now contacting them about the supposed transaction. But they didnt pick up on this, at least so far.

Anyway, its a little scary to be doing this. I still fear the Nigerian mafia. But I figure there is no way to trace a fake email account back to me. Nothing in any of the account set up has anything to do with me at all. For the same reason, I doubt I will post any word for word content that goes on in the emails (in case they get suspicious and know how to use Google). Really, I just want to understand more about these strange emails I have been getting for the past 4 years. Hopefully the enormity of the world wide web will keep my buried in anonimity.

In closing, I do hope that Nigerians arent into perusing other people's blogs.

Thing I love about South Africa #4

2005-11-20T11:24:00.000+02:00

Rusks

I know, you have no idea what this is. I didnt either. But lucky for you, I am here to translate all things South African, good and bad.

Rusks are these very hard, almost stale cookie type snack. Alone, they are pretty gross. Very hard and dry. If you just picked up a box and started eating, you likely would be dissapointed. But they are a biscuit that is designed to be dipped into tea. 4 of them can soak up half a cup of tea in one sitting. First, I should say that, much like in England, tea is HUGE here. Everyday at 10 am or so, people stop for tea. Its another built in break to the day. Since I get hungry everyday around 9 am, this works for me. But dipping rusks in my tea makes it even easier to wait all the way until I can eat lunch at noon.

Anyway, I doubt these can even be bought outside of South Africa. I would imagine biscotti, those hard sweet things they sell at coffee shops are a close relative in the states. But if you find yourself in South Africa with a cup of tea in your hand, these are worth a try.

Not the tallest

2005-11-20T11:10:00.000+02:00

I found a brochure on "The Rock," Gateway's indoor climbing gym (just wrote about this below). They boast that they are the world's tallest climbing gym, at 22.5 meters (about 80 feet). Since I have climbed several times at what I always thought was the world's tallest climbing gym, I thought that this was likely incorrect. And it was.

After some quick research, I learned that Stoneworks Climbing Gym in Carrollton Texas has been confirmed as the world's tallest. I used to climb there often in high school. Its a 6 pack of old corn silos that are over 120 feet high. They cut walkways in the concrete and put holds up all along the inside. Its a pretty amazing place to climb with some really diverse and LONG routes. Its quite odd being at the top of a silo, 120 feet above the ground, barely able to yell down to the person belaying you below.

Anyway, as a proud Texan, I will be forced to confront the folks at the Gateway gym. Although their facility is nice and much more modern, its is 30 feet short of the tallest. Where I come from, that is called false advertising. They could likely boast being Africa's tallest climbing gym, but somehow, that just doesnt sound quite as impressive.

Gateway

2005-11-19T21:15:00.000+02:00

Today we went to the Gateway Theatre of Shopping. Its the largest shopping mall in the Southern Hemisphere and is about 15 minutes outside Durban. I am not one to really enjoy malls. I dont really even like to shop, at all. But we didnt have much else to do and its kind of one of those things you have to see while you are in Durban. What we found was actually pretty cool. I wasnt too excited about the mall itself, but they had an amazing standing wave pool and huge indoor climbing wall.

The standing wave pool was this very larg, foam lined pool that shot streams of water over a curve to simulate a wave. It looked like it would be pretty difficult to control your position on two feet. I imagine I would flop over pretty quick and get plunged backward by the powerful jets. But the guys riding the waves there today were pretty impressive. I didnt try it, but am planning on coming back to give it a full day's effort. I'll be sure to post a picture of me trying, or of my bruises afterwards.

One entire end of the mall seemed to be devoted to surf, skate, and sport. Just about every international (Billabong, Quicksilver) and local surf companies (Island Style, Lizzard) had a huge shop there. I was excited to discover a huge outdoor/camping store. It was all pretty expensive, but its so hard to find good camping equipment in this country. There was also an outdoor skate park, and a climbing wall that had to have been 80 feet hight. Despite my desestation for shopping, it was cool to look through the racks of surf and outdoor clothing that I cant afford.

All in all, I was actually kind of impressed with the place. Sure, it is ostensibly profit driven and entirely overpriced but I know places like this are actually good for Durban and South Africa. While it does make rich people richer, it also gives lots of people jobs. Plus, it will gave me something to do on a Saturday afternoon and now gives you something to read about.

Working hard for my money

2005-11-18T21:22:00.000+02:00

So here is some proof that I actually do work in South Africa. I know I write about surfing and traveling and hiking, but I really do work here on occasion. I have been transcribing patient charts (on the left) in to pages and pages of Case Record Files (the sheets of paper in front of me). It takes hours, and is not all that fun. But the reward is, well, I am not sure what the reward is. I think I forgot. Will let you know if I ever get there.

What I would like for Christmas

2005-11-18T08:40:00.000+02:00

I cant believe people are selling this. Kind of cute actually.

Officially opened by Zuma

2005-11-17T21:06:00.000+02:00

As I was leaving work today, I took a picutre of this plaque on the 1st floor of the building that houses CAPRISA. It was apparently opened by the "Honourable" Jacob Zuma. Ironic that I wrote about and pondered his dishonorable deeds while in the building he opened. I wonder if they will leave this plaque up if he is found to be guilty...

New Email Scam

2005-11-17T15:47:00.001+02:00

Here is a recent email scam I received about the South African World Cup Lottery. This one really cracks me up. Its written very poorly, but note who "signed" the email at the bottom. Who are these people and how dumb do they think the rest of the world can be?

FROM : DR JUDITH KHUMALOLOTTO ZONAL CO-ORDINATOR,JOHANNESBURG, SOUTH AFRICA
2010 SOUTH AFRICA WORLD CUP BID LOTTERY AWARD
Lottery Headquarters: 31, Brixton Court Carlton East Gate
Batch: ( 13/26/DC36.)

CONGRATULATIONS FOR YOUR WINNING

Attn: We happily announce to you the draw of South African 2010 World cup Bid lottery Award International programs held in Zurich, Switzerland. Your e-mail address attached to ticket number: Reference Batch Number is : ( B9665 75604546 199 ) with ! Serial number ( 97560 ) drew the winning: ( 60/84/27/17/36), which subsequently on you the lottery award in the 2nd category. Your name have therefore been approved to claim atotal sum of US$( 1,000.000 ) ( One million United States Dollars) in cash credited to file ( KPC/9030108308/03 ).This is from a total cash prize of US $( 100,000,000.00 )One Hundred Million dollars, shared among the first One Hundred luckywinners in this category world-wide. Please note that your lucky winning number falls within our lottery booklet representative office in South Africa as indicate in the play coupon.

In view of this, your US( $1,000.000 ) ( One Million United States Dollars ) would be released to you by your claims agent immediately he commence the processto facilitate the release of your funds as soon as you contact him. Also your claim included with free flight ticket and one month hotel reservation in one of the five star hotel. All participants were selected randomly from WorldWide Web site through computer draw system and extracted from over ( 100,000,00 )companies and individual emails address. The lottery programe took place to promote south africa ( 2010 world cup award,) For security reasons,you are advised to keep your winning information confidential till your claims are processed and your money remitted to you in whatever manneryou deem fit to claim your prize. This is part of our precautionary measure to avoiddouble claiming and unwarranted abuse of this program by some unscrupulous elements.
( Please be warned. )To file for your claim, please contact your claims agent immediately, you read this message for quick and urgent release of your fund , his conatct information is as:

NAME: MR STEVEN KANIFIDUCIARY
AGENT E-mail :steveklotto@yahoo.com

Please be informed that all winning must be claimed on or before 15th January 2006.You agent will furnish you with his full details to avoid manipulations. To avoid unnecessary delays and complications, please quote your reference batch numbers in any correspondences with us or our designated agent. Congratulations once more from all members and staffs of this program that has succesfully won this competition.

Thank you for beingpart of this promotional lottery program.

signed:
President Nelson Mandela ( chairman.)
Molefi OLIPHANT ( President )
Chief Operations OfficerAlbert MOKOENA
Chief Executive OfficerDanny JORDAAN.

Zuma flew over our house

2005-11-17T12:12:00.000+02:00

Jacob Zuma (the guy on the right) is the former Deputy President of South Africa (i.e. the Vice-president). He was second in command behind President Thabo Mbeki (the guy on the left, pointing at Zuma). Mbeki is only the second president South Africa has seen since the end of apartheid in 1994. The first being Nelson Mandela (not pictured). All three South African politicians are part of the ruling party in South Africa, the African National Congress (ANC).

Zuma was forced by President Mbeki to resign from his position as deputy president based on charges of corruption. He had been involved in a multi million dollar arms deal with a large South African company (kind of like the Haliburton of South Africa). Irregularities were suspected in this deal, and Zuma allegedly solicited a bribe of $80,000 a year in return for protection from the government probe. Essentially, he offered to pay someone this amount if they would simply not look into the matter. Kind of like when you pay the border patrol not to look into your glove box. Thats fine for people sneaking pot across the border of Mexico, but not the kind of behavior you would expect from a Vice President.

So what does all this have to do with me? Well, the President's house is the official residence of high ranking public officials when they come to Durban. Its enormous, heavily guarded, and located about a block from my house. On November 12th, as I was packing for our camping trip, Zuma's helicopter flew right over our house to land at the nearby residence. He was in town for his court date and posted a bail of R1,000. Why he is allowed to stay at the President's house when he is not even the deputy president anymore.

Anyway, Zuma was in town to be indicted basically. His trial wont even start until July 2006, so I am likely to have forgotten about it all by then.

27

2005-11-15T20:01:00.000+02:00

The camping birthday weekend was great. We managed to escape the rainy weather on the way up to the base camp. The hike up to the top of the Sterkhorn was grueling, but it was worth it to finally make it to the top. We got a little wet on the way down, but fortunately had a dry tent and dry clothes waiting for us at the campsite. I cant emphasize how important it is to get your tent set up in dry weather. Makes a world of difference. We spent the late afternoon/evening hiding from the rain, reading, and making tea, soup, and dinner with my tiny camping stove in the small covered area outside the tent.

The campsite itself was awesome. It was set next to a small stream that fed lush vegetation all around us. Good soft ground and the sound of frogs and running water made it a great place to sleep. The water allowed for trees and massive ferns to grow wildly next to the stream. A few meters behind our tent was a small waterfall where you could fill up your bottle with CLEAN WATER. Oddly, there were several mountain crabs scurrying around in pond under the fall. I havent seen these crazy crabs since I was hiking in Nicaragua. I caught one, and thought about boiling him for a snack, but decided we had enough food. Very strange to see crabs out of the ocean, but it must happen in cool, wet climates.

Monday morning (my birthday), we woke to an amazing view from the campsite. The fog lifted to reveal a great sunrise to the East. Behind us, the sun slapped the mountains, lighting up the path we had taken the previous day. The sky was so blue behind the peaks that it almost looked unreal.

In the picture below, the Sterkhorn is the 3 peaks off to the right (not the long broad castle looking peak on the left). You can see a small trail making its way up the grassy hill in the foreground. It was quite a steep hike, essentially straight up with no switchbacks. At the top, you could see over to the other side of the range. Was a nice view when the fog wasnt obscuring it.

We made it back to Durban on Monday afternoon, just in time to squeeze in some surfing. The waves werent the best, but it was a fun longboarding day. The weather is now warm enough that you can get away with just board shorts and a rash guard on a sunny day. The surfing is coming along, I just need some work on my rights, which are backhand for this goofy footer.

We then met some friends for dinner in Durban. We ate at an Indian food restauraunt called Vintage. Was a cool, diverse group of people. We ate too much, and then ate some cake. Finally came home very full, very tired, but very happy to have had such a great birthday.

This birthday was:
-My 27th
-My 3rd in another country
-My 2nd in Africa
-My 3rd in row on which I managed to surf
-My 2nd with Kylie
-My first mountain birthday
-Only 3 away from 30!!

It sounds so old, but I dont feel it at all!

Off again

2005-11-12T12:05:00.000+02:00

We are off again this weekend to hike in the Drakensberg mountains. Are hoping to climb the Sterkhorn this time and camp at the base. Which means we'll be toting all our stuff up the mountain with us. Its been a while since I have hiked up and camped on a mountain, though I did it all the time (with groups of 30) in Guatemala. Hopefully I can manage this group of 2. We are hoping for some sunshine, or at least no rain, but it is the rainy season after all.

Monday is my birthday, so we're hoping for a nice view from the mountain top that day at least. Then, if we dont get washed away, we'll head back to Durban for dinner Monday night. Feel free to join us, I think the last minute airfare is not too expensive right now. If you fly all the way here, Kylie will even pay for your dinner. Have a good weekend!

Idea Post

2005-11-10T21:14:00.000+02:00

I had a good idea come to me today. I decided I am going to pick 3-4 patients at our clinic on ARV's and have brief interviews with them (with their permission, of course). Ask about their lives, their illness, their income, etc. I have been doing this anyway for months now, as a part of working at CAPRISA as a study (junior) clinician. But havent been documenting it at all. Would like to find some that have been on ARV's for a while, and others that are just starting.

I will probably post a lot of this information here (with names changed) and will likely use it in powerpoints when I have to go back and justify what I was spending all this time in Africa for. I hate coming here and only donig a research project. Feels so selfish at times. I think this is a way to combine history taking with pseudo-journalism to help Americans understand what its like to be HIV positive, poor, and South African.

I think if I post my ideas, I will be more likely to follow through with them. But dont want to get too ambitious, I still have to try and dupe some Nigerian email scammers.

2005-11-10T18:14:00.000+02:00

JJ pondering the jump. His teenage competitor is in the foreground in the pink. Ironically, all four surfers in this heat couldnt paddle past the break. They all were washed ashore, and had to walk back out to the pier, and jump again.

2005-11-10T18:12:00.000+02:00

Surfers being briefed before the competition. That's JJ in the polka dots (the 44 year old competitor)

2005-11-10T18:10:00.000+02:00

Here is a picture of the massive waves hitting the New Pier in Durban. Notice the sets in the background.

Goodwaves

2005-11-08T17:21:00.000+02:00

Kylie and I woke up early this morning to meet Lisa and Sara at Addington Beach to surf. Sara and Lisa were new to the sport, and wanted to surf a more tame break, so we skipped North Beach and headed a little further south.

We arrived a little ahead of them, just before 6 am. When we pulled up, I could already tell that something strange was going on with the ocean. Firstly, the horizon was not flat, like it normally is. It was bumpy, for lack of a better word. Instead of a straight line, there were perfect sinusoidal shapes, evenly spaced. You could also see massive waves breaking just below the horizon. Not at the beach, where things were relatively calm, but about a mile or two out, waves were whitecapping, and tumbling over. I had never seen waves break that far out. Strong offshore wind blew the tops off the wave in an arc of trailing sea spray. It was too far away to hear, but it looked loud and powerful.

I often have a recurring dream about large waves that moved parallel to the shore. I am usually driving along the seawall in Galveston, watching waves break the same direction that my car is moving. I always thought this was impossible, until today. Waves about a mile out were literally traveling parallel to the shore. Some were breaking, others were simply rolling along like big huling blue monsters.

What might seem confusing, is that the beach where we surfed, the waves were relatively small. The waves were only about 1-2 feet tall. Perfect for longboarding, but really kind of boring. You might wonder how this is possible. Its a trick of swell and protection. I'll explain.

Groundswell occurs when a huge storm somewhere several hundred miles offshore roughs up the water. The swell is initially powerful, but disorganized and choppy. As it spreads out over the hundreds of miles between the beach and the storm, the waves sort themselves out. They organize, and roll onto shore in great big lurking waves, evenly spaced out with a smooth, polished surface. Groundswell is what makes for classic surfing conditions. Sadly, in Galveston, groundswell rarely occurs. Usually we are only lucky enough for some choppy windswell (the kind of waves that occur before they have time to organize). Only big hurricanes really bring the groundswell. But in Durban, groundswell is really the only thing that is surfed.

Like any wave, groundswell can also refract around edges. The massive groundswell I saw rolling across the horizon was actually created by a huge storm way down south of Africa. The waves were rolling up, and almost wrapping around the coast by the time they hit Durban.

However, where we were surfing (near Addington hospital in the map to the right) the shape of the shore line was protecting the beach from the massive swell coming in from the south. In the image to the right, imagine waves rolling in from the bottom of the map, but refracting a little around and inward. The mouth of the bay (North and South pier) were blocking much of the refracted swell. So, where we were, the surf was pretty timid, but still kind of fun.

After a quick hour of catching thigh-high waves, we loaded up the boards. I decided I wanted to go have a look at North Beach, and maybe surf there if there was time. The mouth of the bay doesnt offer as much protection further north, so I knew the waves would be much bigger up there. I had never seen the ocean move like this before, I wanted to see what was happening up there.

So we made the short 2-3 minute drive up to North Beach (one could walk it in about 5 minutes). What I saw there was unreal. Enormous waves, some 10-15 feet tall, exploding into the pier. There were red Quicksilver flags running all along New Pier. I surf there most days, and had never seen them before. There were about 10 people in the water surfing, and several others standing on the pier, board in hand, waiting to jump off. People were catching lots of the huge waves rolling in. Surfers and bodyboarders would drop in on the giant towers of water and carve whitewater along the face. When the waves broke, they exploded in a dynamic wall of whitewater and hiss. It was truly amazing to witness.

Those jumping off the pier had to time their jump perfectly. If they jumped at the wrong time, a huge wave could toss them back into the pier with a lot of force. Many jumped, cleared the pier, but couldnt paddle past the massive break and were washed back to the beach. They were all experts at duck diving, where you essentialy push you and your board uner the breaking wave (see image at right). Even if they were washed ashore, they usually reappeared at the pier 10 minutes later for another jump. They all looked to be about 16.

For an instant, I thought about going to get my board. This was a once in a lifetime opportunity, and I was on the sidelines. But then I remembered that I would undoubtedly die if I tried to brave this surf. Either that, or be rescued by the many jet skis zipping around, making sure no one drowned. That seemed like an embarassing fate, possibly worse than death. So I swallowed my pride, and we sat and marveled at the amazing display of natural power unfolding before us.

The Quicksilver flags were up because the next day they were holding the Goodwave Surf Competition. This is a once a year event, held on the day that the judges predict the surf to be the best for that season. Unlike any other surf contest in the world, this contest does not have a scheduled date. They simply wait all year for the biggest and best day, and call everyone up. Often, surfers are off in other competitions, and local alternatives are invited to join.

One of those locals happens to be the guy who introduced us to Durban surfing, JJ. JJ gave Kylie her first lesson, and helped us find the shaper who designed our boards. He is 44, and is at the beach every single day. I think everyone who surfs in Durban knows him, and I dont think anyone knows his last name. He is friendly, energetic, and I only understand about 70% of what comes out of his mouth (he speaks quite quickly and in thick surfer lingo). Tomorrow, he'll surf in the Goodwave against teenagers, less than half his age. Needless to say, we'll be there to cheer him on.

It was a truly phenomenal day. I have never seen the ocean display so much power, yet power that was so organized and focal. Sure, part of me wished I was one of the brave souls diving into the ocean to surf this once a year swell. But really I was just grateful to have caught a few waves that morning and been around to witness such a unique aquatic experience. I cant wait to get up at dawn and do it again tomorrow.

I love duct tape

2005-11-07T20:55:00.000+02:00

Duct tape is absolutely one of the most useful products on the planet. Especially for anyone living overseas. After several trips, I have learned never to leave home without it. If you are planning a trip, put it on your must bring list. Here are a few of the ways duct tape has changed my life.

● Duct tape makes a decent waterproof seal for temporary surfboard repair. Its typically advised that if you ding your board, you should get it repaired before getting your board wet, but if the surf is good, it can be a useful temporary fix to keep the water out.

● I tore my sleeping bag while leading a hike in Guatemala and knew that down feathers would leak out for the duration of the hike, thus rendering my bag useless. But a little duct tape over the hole, and the bag still works perfectly.

● The last time I was in South Africa, my nice Nikon camera broke. The film compartment wouldn’t close. I was terribly disheartened, wondering how I would possibly get it fixed. But a 4 inch piece of duct tape brought the camera back to life for a few more years of good picture taking.

● We recently used duct tape to try and catch a cockroach in our kitchen. We hoped that the little bugger would crawl over the tape and get stuck on the sticky side. We even put a cracker in the middle to entice him onto the trap. This didn’t work out as well as the aforementioned examples. In fact, it didn’t catch much except my big toe.

● We recently used duct tape to repair the handle that rolls our window up and down (aka the window-roller-upper-and-downer). Amidst a furious roll, it snapped in two and I thought I was going to have to roll the window with my fingers. But duct tape to the rescue, and the window still rolls up quickly in the rain.

After thinking about it, I realized one major problem with using duct tape. It works so well, that you think you have solved the problem. Almost all of the examples above started out as temporary repairs. But I never got around to really fixing them because the tape worked so well. Our sufboard is still sealed by tape, my sleeping back still has the same piece from 4 years ago, and my camera went through seveal strips of tape until it was finally stolen 3 years later.

So, I guess the moral of the story is dont leave home without duct tape. But once you are home, get your equipment fixed properly or you'll be left with that awful sticky grey residue that duct tape unfortunately leaves behind.

Finally, while I do love the stuff, I think my passion for duct tape pales in comparison to these guys' love for it. Their site is pretty funny, and even uses Napolean Dynamite quotes when you switch between pages.

Going undercover in the Nigerian email scam

2005-11-07T20:51:00.000+02:00

For years now, I have been getting emails from people posing as friendly (and often illiterate) Nigerian lawyers. Its always some sort of a scam thrown together in pseudo-cerebral English. They apologize for contacting me via email, they tell me about some American that has died whose last name is also Wiseman. They invite me to enter into a "deal" with them where they transfer the money to my account if I just offer my honest cooperation. Just to give you a sample, here is a typical email below:

Attn:Dear Wiseman I am Barrister peter c ibeh personal attorney to Late Mr.Ron Wiseman ,a national of your country, who used to work with Shell Development Companyhere in Nigeria herein after shall be referred to me as my client. On the 21st of April 2003, my client, his wife and their two children were involved in a ghastly motor accident along Warri- Sagbama Express Road. fortunately, all occupants of the vehicle lost their lives as the vehicle caught fire after the crash. Since then I have made several inquiries to your embassy to locate any of my clients extendedrelatives this has also proved unsuccessful. After these several unsuccessful attempts, I decided to track his last name over the Internet, to locateanymember of his family hence I contacted you. My purpose of contacting you is to assist in repatriating the money and property left behind by my client prior to his death before they getconfiscated or declared unserviceable by the bank where this huge deposits were lodged particularly, the BANK where the deceased had an account valued at about US$15.5 Million dollars.The bank had issued me a notice to provide the next of kin or have the account Confiscated within the next ten official working days. Since I havebeen unsuccessful in locating the relatives for over 2 years now I seek your consent to present you as the next of kin to the deceased since you havethe same last name/surname so that the proceeds of this account valued at US$15.5million dollars can be paid to you and then we can share the money.I have all the necessary official and legal documents that canbe used to back up the claim we may make. All I require is your honestco-operation to enable us in seeing this deal through. email me at barrpetercibeh_111@yahoo.com

I particularly like this one where (I assume) he mistakenly wrote "fortunately" instead of unfortunately when telling me that all occupants of the car died in the "ghastly" accident. I sometimes get a kick out of imagining a bunch of Nigerians sitting around a computer with a thesaurus, looking up words like ghastly.

Even though I laugh at most of them, they really kind of piss me off. They clog up my email for one thing, not to mention the thousands of other people that receive these. But I also have to remember that they are quite obviously trying to steal my money.

So, by now my curiosity has gotten the best of me. I have decided to make up a fake email address and am going to play along with one of them for a while. To be honest, I am a little nervous to try this. What if these are Nigerians, but are working out of South Africa or even Durban. What if they find out who I really am and I find myself at the mercy of the Nigerian mafia? All of this is not likely. But, like many other South Africans, I have a healthy fear of Nigerians (they are responsible for a lot of the violent crime here). Still, I think if I set it up right, there will be no way to trace it back to me. I'll set this up over the next few days, and let you know how it turns out. I have a feeling their email addresses dont even work, but we'll see.

Venezuela, Argentina, poor Bush, and of course, AIDS in Africa

2005-11-04T18:07:00.000+02:00

Yesterday, the Venezualan army staged a mock invasion of its northernmost shores. Troops stormed the beaches in an effort to simulate what an invasion might seem like. Who might invade Venezuala? Well, the USA, of course. That's right, Venezuela staged a mock invasion to prepare for an invasion via Venezuela's Carribean shore. Their logic was that if we invaded Iraq and Afghanistan for their oil, why wouldnt we target Venezuela.

I find this just as humerous as I do disturbing. The thought of Hugo Chavez feeling so concerned that we might invade his South American country that he felt a need to simulate the invasion to prepare for it, is well, kind of funny. I think our government is often up to no good, but I seriously doubt we have any intention to invade any country in South America.

What really bothers me about this is that all of Venezuela seems to think this is a possibility. Sure, its ridiculous, but are we that poorly respected in the international community that a South American country would really believe we might invade their shores for oil? Apparently so. Seems like the mark of a low point for Bush and the US.

To make matters worse, Chavez and other South American celebrities organized a protest of Bush in Argentina. As Bush attended the Summit of the Americas, he seemed to trydesperately, and pretty pathetically to improve his and the US's reputation among South American countries. Apparently, thousands protested Bush's appearance at the summit. Bush weakly tried to find common ground by mentioning Argentinian basketball player Manu Ginobili, who plays for the Spurs. Was this supposed to make Bush and Argentina buddies? It seems kind of desperate to me. Like playing the name game with someone who doesnt like you very much to make ammends. I can only imagine Bush's internal logic:

"Well, they like this basketball player guy, this Ginobili. And he plays basketball in Amurca. And in Texs! Well, I'm from Texs, so, I think I'll mention this guy, yeah, that should smooth things right over, he's an abassadur, yeah, a baskebaul ambassadur..."

At this point, I kind of feel sorry for Bush. I never really liked him much, but his second term is going so badly that I almost feel bad for making fun of him. In all seriousness, the reasons its going bad arent really funny.

Despite all this, I will say that I dont think Bush is all bad. He has done som good things as president. One of which happens to be funding the antiretrovirals that we dispense every day at our clinic here in Durban. The President's Emergency Plan for AIDS Relief (PEPFAR) is making a good, positive impact in Africa, and for that, I commend our poor president who is the most unpopular he has been in the past 6 years. As long asI am defending myself, I should also state that I really dont like Hugo Chavez, at all. Anyone who shakes the hand of Rober Mugabe is not to be respected in my book, no matter how much they dislike Bush.

Finally, I just read this about Bush and Chavez at the summit:

"Bush and an outspoken critic, Venezuelan President Hugo Chavez, also were likely to meet Friday, shortly after Chavez's speech to a demonstration of mostly anti-Bush protesters. Chavez has joked about whether Bush is afraid of him and said he might sneak up and scare Bush at the summit."

Now that would be hilarious to see. I cant even imagine what would happen if one president tried to scare another at a summit.

So, thats my Friday evening ramble. We're still without a car, so I dont have much better to do. Venezuela, Argentina, Bush, and always, back to Africa. Cant seem to leave that one alone.

Little Dogs

2005-11-03T15:23:00.000+02:00

One of Kylie's friends saw our Hot Dog pictures and sent us this picture. Thought it was pretty clever, but not nearly as fun as our life size version.

Gaskets and Geography

2005-11-03T14:29:00.000+02:00

Our 1991 Ford Sapphire has turned on us once again. We drove it to work Wednesday morning and it started smoking. The engine was piping hot. We let her cool off, and drove to the mechanic that we kind of trust. Apparently the water pump had broken and the car was overheating. No problem though, could be ready that afternoon. At least that was the story. But then they called back to tell us the head gasket had broken. I had no idea what that was either. A gasket is apparently any watertight seal in the car that keeps oil on one side, and water on the other. The head gasket surrounds the cylinders (where the gas is combusted) and has holes where tubes of oil and water run through the head block (see the exciting phot on the right). The water had stopped, and the engine overheated. This melted the gasket, and leaked oil into our water tank. Would take more money and a few days. Awesome.

Dan Johnson, if you are reading this, you should feel bad for selling us such a car for the price we paid.

Dan was the Fogarty Fellow before me. I naively bought his car from him before I arrived. I actually dont think he meant to sell me such a lemon, and his helpful advice so far has made it hard to ever be mad at him for this. Besides, I will likely sell this car to the next unsuspecting buyer for more than its worth, and the cycle of deception will continue.

So the result has been us being stuck at home with no car. Luckily there is lots within walking distance, and friends have offered rides to help. But I have spent way too much time with my computer lately. Obviously not all of it was spent updating the blog. I have been working a lot on my honor's thesis proposal. Its kind of the one thing I want to get done while I am here. Its an opportunity offered by my medical school and you graduate "with honors" if you complete the thesis. Its proving to be a lot of extra work, and I am just getting started. But I figure I am taking an extra year to do research, so I might as well get it done. Still, not fun to sit at home and synthesize a background all day when its your only choice for entertainment.

I also just discovered a new very cool website called Geography Zone. Its this great site that tests your knowledge of world countries. The cool part is that you compete with your country and it keeps a running average score for all the countries in the world. I must credit Nupe with telling me about it. He is a fantastic fellow nerd, and we have a lot in common (one thing being our oft mispronounced first names). Anyway, I have taken the Geography Challenge many times today, and its been hard trying to discern Turkministan from Kajikistan. The break up of the USSR must have wreaked havoc in the geoography world with the addition of 15 new countries, most of which end in -stan.

Well, this is not the most exciting entry I have posted. Gaskets, thesises, and geography. But my life hasnt been too exciting lately, so there you go. If things dont pick up, I'll just make something up here pretty soon.

Hutu rebels moved back into Rwanda

2005-11-01T20:39:00.000+02:00

I found this article about UN soldiers forcing Rwandan Hutu rebels out of the Congo, back into Rwanda. Before I had seen the movie, Hotel Rwanda, I doubt I would have looked at this twice. But the movie made a permanent mark in my memory.

If you havent seen it, it depicts the slaughter of almost 1 million Rwandans. Tension between the two ethnic groups the Hutu and the Tutsi has been a problem in Rwanda for decades. But in 1994, they had been living relatively peacefully. Then, the Hutu decided to take over the government and slaughtered hundreds of thousands of Tutsis, often with machetes. This was all on the heels of the US military catastrophe in Mogadishu, Somalia (ever seen Black Hawk Down?) and the US and UN were reluctant to intervene. Close to a million Rwandans (almost all Tutsis) died before the genocide was stopped.

I hate admitting this, but I barely remember this happening. Its an endictment of our world, and of myself, that it took a major motion picture to bring this to my attention. Close to a million people, were murdered. More than double the Asian Tsunami, and these deaths were entirely preventable. I think of it as one of the darkest moments in human history. I am also reminded of Tom Cruise's character in Collateral. He is an assassin that justifies his murder by the fact that millions of Rwandans died in 1994, and barely anyone knew about. He is obviously wrong, but it makes a strong argument.

Anyway, after having seen the movie, this article made a lot more sense. The Hutu responsible for much of the genocide fled into the Congo (after being driven out by the Tutsi counter-rebellion) and continued to launch attacks in the area. But now the Congolese army and the UN are driving them back into Rwanda.

To me, this doesnt make too much sense. Wont they be likely to cause even more problems in Rwanda? I wonder how the Hutu government feels about this. I suppose its not really theo Congo's problem, and maybe its the right thing to do. But really, I suppose there is no way to get past the scars and deep sentiments that follow from something as awful as genocide.

Finally, I just realized I mentioned 3 movies here. Interesting what effect, both good and bad, can have on a person's perception of the world. And I highly reccommend 2 of the 3 aforementioned movies (dont see Collateral though).

The Life Aquatic

2005-11-01T19:30:00.000+02:00

I have never seen a more sea friendly city than Durban. So much here revolves around the ocean. Its one thing I have noticed and really admired about this city. Let me explain.

One of the first mornings I went out to surf at North Beach (I had NO idea what I was doing back then...) I remember feeling kind of cool to be out in the ocean, 200 feet or so off the shore on my board. I was out past the break, ready to catch some waves. Then a gang of 13 year old girls paddled by me, giggling about some boy. I realized I wasnt the only one floating around that area of the ocean. Suddenly I felt a little less cool. These girls were all paddling on Malibus. A Malibu is kind of like a surfboard-boat. Its long and shaped like a board, but you kneel on it, and really made for lifesaving. You can catch waves on it, but its really for fitness. Its very common for sea-friendly families to grow up training on a Malibu. There were about 20-30 girls, all training together, paddling parallell to the shore.

A while later, I noticed a group of heads swimming over and through the waves toward me. These people didnt even have a board, they were out past the break, simply going for a swim. When they got close to me, I realized they were all in their 60's. Suddenly, I felt a lot less cool.

Regardless, I am really amazed at how ocean oriented Durbanites are. They come to the ocean on long boards, short boards, body boards, Malibus, wave kayaks, fishing kayaks, sea kayaks, and of course, with just themselves. Its normal to me now to find myself surrounded by 20-30 surfers, a fleet of Malibu kids, some elderly swimmers, and the occasional dolphin when I head out to surf in the morning. Many times, I see the same kids getting dressed for school in the parking lot, with mothers or fathers either waiting, or changing out of a swimsuit themselves. And all this is usually well before 7 am. Except when they get in my way, its kind of cool to see all these people enjoying the sea so early in the morning. Kind of makes me wish I had grown up near the water. But I am near it now, and doing my best to be in the ocean as many days as weather and work will allow.

Halloween Hot Dog

2005-10-31T20:07:00.000+02:00

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?

2005-10-30T20:31:00.000+02:00

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

2005-10-30T20:01:00.000+02:00

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...

2005-10-30T19:47:00.000+02:00

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

2005-10-29T17:10:00.000+02:00

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

The wall of Zulu

2005-10-29T16:08:00.000+02:00

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

2005-10-28T13:54:00.000+02:00

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

2005-10-28T10:01:00.000+02:00

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

2005-10-24T07:58:00.000+02:00

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.