Home Again

Morning view from my front porch.







Clothing optional beach.








Beach closed.









My neighbors across the valley.









.. In Johannesburg I spent a half day as a tourist. Went 700 ft. down into an inactive gold mine, saw a live pour of molten gold, and wandered around the gold museum. An amusement park has grown up around the mine, and the Apartheid Museum is across one street and a casino across another. I could have spent another full day in that neighborhood, but had to catch a plane home.

The trip home was a marathon. Eighteen and a half hours on the plane, including a stop in Dakkar where we weren't allowed to get off. The people in the seats next to me did get off in Dakkar and I thought I'd have a little extra room for the last eight hours, but 2 teenage boys from Gambia got on to take their place. They asked for my help a couple times, to work the interactive video and to fill out immigration and customs forms, but they slept most of the way to Washington. After an hour in line at customs, had just enough time for a cup of coffee before the flight from Washington to Syracuse. The sight of my daughter at the airport was the high point of my trip.

It's been a little difficult adjusting to the 6 hour time difference. I woke up at 3 AM today and didn't really get back to sleep till I had to get up at 6. I'll try and skip my afternoon siesta today and see if I can stay up a little later and sleep in till 6 tomorrow.

Yesterday I got my pictures developed. Yes, old fashioned film. Here are a couple from one roll. I'm still not quite sure how to put on captions, but maybe they will magically appear.

Heading Home

Packing

Tomorrow I start heading home. A two day trip with a 20 hour layover in Johannesburg. Should be able to get a night's sleep and be a tourist for a half day.

Yesterday I had 8 people show up at my afternoon lecture. A new world record. At first only interns would come to the lectures. Then a couple COSMOS (Community Service Medical Officers) started coming. And yesterday one of the senior medical officers appeared. Too bad that I have to leave now that I'm on a roll.

Today there was a shortage of consultants to get the first cases of the day started. So, I deputized myself and helped one of the medical officers start anesthesia on a 3 month old for a VP shunt. Then I went out to the orthopedic hospital to help. Broken humeruses and elbows seem to be the diseases of the week.

Tonight the volunteers are getting together for dinner at a local restaurant, Ebony. Ebony and Ivory. Does anyone have tickets for a Michael Jackson show? I haven't heard any news about him or Paris Hilton for 2 1/2 weeks. I am officially out of the loop.

Weekend

A couple nights ago the volunteers had dinner with a priest who was a chaplain for the ANC (Afican National Congress) when it was in exile in the 80's. He had a few stories about being deported, jailed and generally harassed when he was in South Africa during the fight against apartheid.

Yesterday was my big trip to Port St. John's on the Indian Ocean. Driving on the left wasn't quite as difficult as I expected. Avoiding people, cows, horses, sheep, goats, and mules every few miles was. The road itself was pretty good, but slowing down from 60 mph to avoid jaywalking cows was a test of reflexes. When we got to the beach the shark flags were up so I didn't go swimming. But the restaurant overlooking the bay was open and we had a leisurely lunch. The town itself was busy, hot and dusty. Most of the small surrounding villages don't have anything more than small convenience stores. It looked like everyone had come to town to shop and stock up on supplies for the week. Sidewalks were filled with vendors and people overflowed into the streets.

Today I went to the cathedral for Palm Sunday services. There was a blessing of the palms and a procession down the street into church. I taped the music on my cell phone. Maybe I'll be able to put it on the blog when I get home. Halfway through the Gospel I had a sinking feeling. Last week they read the Gospel in both Xhosa and English. Would we have to listen to the Passion twice? It was already over 80 and the church was packed. And of course, no air conditioning. But we only listened to the Xhosan translation. For some reason we sang three songs in the middle of the Gospel. All together, with the blessing of the palms, the procession, the longest gospel of the church year, a sermon, and about 20 assorted songs the Mass lasted 2 1/2 hours. This would not be acceptable back home.

This afternoon will be a shopping day. They have a local red table wine from Chateau Libertas that costs $2.50 a bottle but they have been sold out at the nearest liquor store. And I'd like to get some music. I bought a CD from the South African Music Awards which had 21 different artists. The "Gang of Instruments" had a pretty good track, so I'll get one of their CD's. Fololo, a local jazz musician, has something coming out this week. If I had planned ahead I would have made plans to go the Capetown Jazz Festival this weekend. Too bad it's 700 miles and a 13 hour drive away.

Itipini

Sorry for dwelling on the power and water outages. These temporary inconviences are nothing compared to spending every day without power or running water as many people do. There are between 125,000 and 300,000 people in Umtata and the surrounding areas. I couldn't guess how many live off the grid. Unemployment is between 50 and 70%. Between 10 and 25% of people carry HIV. It's hard to make estimates because stigmata of having the disease keeps people from being tested. People are a lot alike everywhere.

Today I visited Itipini. It's a shantytown built on an abandoned dump on the edge of town. Even though I had seen pictures and knew about the clinic there, I wasn't quite prepared for what I saw. No electricity or running water. "Houses" built out of discarded pieces of wood, tin, plastic, canvas and whatever else could be scavanged. But, the people were friendly and the kids were great. The sight of a camera was cause for big smiles. How can people with so little appear so happy? It you want to see pictures by a professional photographer, google "Itipini". If you wan to read a blog by a professional journalist/volunteer, google "Jesse Zink" or "Mthatha".

This morning I was at the orthopedic hospital 6 km. from town. Helped take care of a 6 mo. old with osteomyelitis of the forearm and tibia. And then a patient in the High Care Ward (ICU) with a cervical spine injury had a cardiorespiratory arrest. He was resuscitated, but since they don't have ventilators, he came to the OR and was kept on the anesthesia ventilator till the ambulance arrived. Luckily I didn't have to ride to town over the pot holes. The EMT's seemed competent as long as we provided them with a tank of oxygen and an Ambu bag for the trip.

Three Days

After being here a week I am adjusting to a different rhythm of life. There are three kinds of days: Water days, Power days, and Power & Water days. Yesterday was a Power day. Today we had both Power and Water. Everything at the hospital worked. At least till the suction failed in the afternoon. The anesthesia machines are brand new Ohmeda S/5's, but the probes fail quite regularly. There are sometimes extras around if a room is not being used. Sometimes not.

Part of my day is spent on ICU rounds. Several tragic trauma cases. Relatively young people involved in accidents at places 2-4 hours away. Poor prognosis for what look to me like non-life threatening injuries.

Next weekend I hope to see the ocean. It will mean renting a car and driving a standard transmission from the right side of the car. The local traditional healers are alleged to be throwing bloody carcasses into the ocean at Port St. John's. This seems to attract sharks. Who have attacked two surfers this year. Statistically, I think I will be safe swimming. There have only been two attacks so far this year. And they have been in deeper water. On the other hand it will be even safer on the beach. Port St. John has a small artists' colony so that is another reason to go. Or, I could go to a traditional village and sleep in one of the round houses with a thatched roof. Either choice looks good.

Oppression

Yesterday was a mild 80 degrees. Today the heat was oppressive. Sunny and 90. Luckily the power is back on and the air conditioning in the operating theatres is working.

I forget to tell about my trip to church yesterday. I wasn't sure where the church was or what time services were or even the name of the church. Opinion varied. But I walked into town and started walking in the general area. There was some pretty good music coming at the Universalist Church and told myself I'd convert if I couldn't find the Catholic church. But I kept walking and just before 10 saw people heading down a side street. What luck! The cathedral. When I entered everyone stood up and started singing. What I didn't see was that the bishop and about 10 deacons and altar servers had entered from a side room and were following me. For a couple seconds I thought the welcome was for me. But the place was rocking. The entire service lasted 2 hours, including over an hour of singing. The songs were in Xhosa, as was about half of the service. But there was plenty in English, and even the Xhosa wasn't much different than the Latin Masses when I was a child.

Today I went to Bedford Orthopedic Hospital. It's a 180 bed hospital about 5 km outside of town in the middle of nowhere. But they had 3 operating rooms going all day and did 16 cases.
Mostly fractures and infections. I helped with a few of the pediatric cases and then showed the consultant and resident how I do an interscalene block with a nerve stimulator. The patient weighed about 140 lbs. and we could practically see the groove. The block worked and I finished up the day going back to Nelson Mandela Hospital to give a lecture on muscle relaxants.

Earth Hour

Last night we were supposed to turn our lights and electrical appliances off at 8:30 for an hour like everyone else in the world. The power went out at 8 and was off all night. We are all set for Earth Hour for the next 13 years.

Yesterday I went to the Nelson Mandela Museum in downtown Umtata. The presentation was well done. Two wings of the museum have gifts and awards he received when got out of prison and was then president. One of the gifts was a South African flag with an impressionistic picture of Nelson Mandela painted on it by Leonard Nimoy (a.k.a. Mr. Spock). It may have been a gift from the Vulcan Government.

Yesterday was also a shopping day. The volunteer physical therapist picked up a battery powered Ryobi drill to use in the orthopedic outpatient clinic. They have a way to keep it sterile and use it there to put in pins so patients don't have to be admitted for some of the smaller fractures. On Tuesday I will be visiting Bedford and see if they are really using it. It cost $39.99. I wonder how much a Zimmer drill costs?

Not much to do when the power goes out at night. It's too dark to go out for a walk. My computer battery lasts about 2 hours so I can work on lectures and watch DVD's for a while. Best thing is to sleep.

Friday

The power came back on. And water started flowing again. But today I am roughing it. My house has a small washing machine, but no dryer. I had to drag the clothes rack outside. 90 degrees and sunny with a little breeze, so shouldn't take too long. Last night I boiled eggs and made a sandwich for dinner. The eggs were cooked to perfection.

I was going to go to the orthopedic hospital today, but for some reason the cases in all 3 rooms were cancelled. The assistant chief of anesthesia here says they may be taking inventory. With all the shortages of supplies and equipment I wouldn't think it would take the entire staff all day.

This afternoon I was going to go to Itipini, the shanty town built on an abandoned dump. They told me the clinic didn't have any patients, so I stayed here at the Nelson Mandela hospital. Cases were pretty much done by noon. Everyone was glad to leave early.

Tomorrow I am going to the Nelson Mandela Museum and look for a one hour photo developer.

No Power. No Water.

The power did go out for good last night. Walking home in the dark without streetlights or road signs was a challenge. But watching the electrical storm from the front porch was a real treat.
This morning there was still no power or water. Not just for me, but also for the residents and the staff that live on the grounds of the hospital complex. And the hospital was on auxillary power, so the air conditioning wasn't working. All day long we watched the temperature rise to 29 degrees C (85 degrees F). Which only got us ready for going outside where it was sunny and over 90 degrees F. I thought it would be colder here in the Fall.

The hospital does not have a cafeteria. The only food or snacks are in a Coke machine on the fourth floor. But that isn't hooked into the auxillary power and wasn't working today. And there was no power for the projcetor for my lecture. And because it was so hot I cut the lecture short.

It's taken a while, but I think I've figured out the difference between the consultants, house officers, community service physicians, and interns. Consultants are residency trained and board certified specialists. House officers can spend their entire career as house officers. The community service physicians are not serving time for a criminal offense. Interns are still just interns.

Today I was in the pediatric room. Saw the excision of two hydatid cysts in a liver, the excision of a cervical cyst and an umbilical herniorrhaphy. Surgery is supposed to start at 8, but the patients usually don't arrive in the OR till 8:15. And with delays and equipment issues, anesthesia doesn't start till 8:30. And with luck, surgery starts at 9. Today there were problems with an oximeter and a capnograph. There were no spares, so we waited till the technician got them working again before proceeding. People are so accustomed to delays that no one seemed upset. As a corollary, coronary artery disease is not very common here.

Time to find a church and pray that the water comes back on soon.

Weather Report

Sunny. 85. At least till the thunderstorm came over the mountain and down the valley a little while ago. The power and internet access have been off and on a few times. This will be a short story today.

Restaurant Review

Wimpy's, at the domestic flight terminal of the Johannesburg Airport, has one of the best breakfasts in the world. It was the only place open this morning at 5 while I was waiting for the last leg of my trip to Umtata. Two eggs, two pieces of bacon, two sausages, a tomato, one slice of toast (in deference to Dr. Atkins) and a cup of coffee for $4.62.

The flight from Dullles was OK, but too long. No stop in Senegal, so 15 hours in the air. Luckily the seat next to me was empty so I could spread out a little and get a few power naps in.

The person who met me at the airport is a volunteer here in Umtata. He has his own blog, though I forget the name. You can google Jesse Zink or Mthatha to get to it. It has pictures and is infinitely more interesting than my blog.

Tomorrow I start at Nelson Mandela Hospital. It is just down the hill from my house and looks like an easy walk. As best as I can tell, I will be working with rotating interns, house officers and medical students, though they have different titles here.

Dulles

A six hour layover at Dullest. Not a whole lot longer than some laparoscopic surgeries. And I get to walk around and eat and watch people and doze off once in a while. So maybe it's not too bad of a wait.
It's a little too early to say how full the plane will be. It's 45 minutes before boarding starts and it looks like there are only about 50 people here at the gate. That includes the two kids crying over in the corner. Make a note to self: Find my earplugs.

Tomorrow

Tomorrow is the start of the two day journey to Umtata.  First, a short flight from Syracuse to Washington.  Then a few hours at Dulles Airport, followed by fourteen hours in the air to Johannesburg with a one hour gas stop in Senegal.  Finally an overnight stay in Pretoria before an early morning flight to Umtata.  I hope I have enough crosswords, books and journals.  My computer batteries are only good for about 4 hours.  Maybe I should see what will be playing at South African Airways Sky Cinema.  I can always finish packing in the morning.

One Month

Next month I'll be on my way to Umtata, South Africa as a volunteer instructor of anesthesia at Nelson Mandela and Bedford Hospitals.  With luck I'll be able to add updates and photos.