Sunday, April 19, 2009

All my pictures are of Joe

Joe and I have spent a good portion of our weekend in these chairs. I'm taking the picture from our front door. Past the garden you can see the chapel at the convent. A minute later Sister Charity came by, moved Joe's cell phone onto his flip-flops to protect it, I suppose, and walked away. Later she came back to plug in her cell phone using our adaptor because Sister Lucy doesn't know she has a cell and would disapprove. She also asked me if I was marriaged, told me she read an article in the American magazine (do I know "The Magazine"?) that said that people who had a true love sometimes got divorced. She then asked me if it was possible for a black woman to marry a white man from America. "That makes me frightened." I told her that in America you can marry people from anywhere. I decided not to get into recent advances in gay marriage laws so as not to blow her mind all at once. Jeepers.
Mrids, Joe, Libby, Phil: half way up and taking a breather. It was a bit hand-over-foot scrambly.
The top of the rocky hill behind the public health interns' abode: it was maybe a forty minute trip up? We wound through the yards and animal trails of a little piece of village. Kids waved, called us "lahoua" (foreignor), and laughed. Ah, the joy of being an endless spectacle...
Mmm, "Puerto Rican" corned "beef" dinner. I was super skeptical but it was actually quite good. Add tomato sauce and veggies and spices to any meat-like product and things turn out well.
Joe is back from communing with the wild goats of Taba Joyner (I think someone had already claimed this land, but Joe has renamed it). For some reason I can't upload the other pics from today's little hike up our backyard mountainlet and I need to go home and get the pizza dough spread out for yummification. Sorry for the brevity! (Oh, nevermind; it's working now. Pics are in a funny order because I can't change them once they're up.

Love you, home people!!!

Saturday, April 18, 2009

Horse stickers, cable needles, and time differences

This kid has single-handedly nearly exhausted my supply of horse stickers. I think his sister is here as a patient and he is just a boarder. He sure seems healthy.

Aah... here's the coy, knowing look he gives me while leaning against buildings or briefly stopping whatever game he's playing. I'm a total sucker. I'll have to bring in the "playful pandas" book on Monday since I only have one horse left. There are lots of horses in Lesotho but will he ever have seen a picture of a panda before?
I don't know if this is his grandma and brother or just some folks he's made friends with since he's been here (the whole time I have). They were all reduced to giggles looking at pics of themselves on my camera.

Alright, the race is on. One of my best friends from high school is looking REALLY and GORGEOUSLY pregnant in her update pictures and my knitting is totally stalled because I don't know how to twist my cable! I can't skype with my mother for another four hours or so because she's asleep (the nerve) so I'm downloading a video from www.knittinghelp.com which looks very promising. The woman has a calm voice and has already said things like "the basic idea" and "so, all it is..." so I think she'll be able to help me. Most of my goal for today invovles sitting in the sun with hydrating liquids, music, and soft yarn.

I've hit a point in this trip where I just want to stay. Not all the time. Sometimes I want to hop in the car with my kayak on top and bikes on the back and tent in the passenger seat and drive across the U.S. to start my Seattle life. Sometimes I want to be floating in a swimming hole in Ithaca or mountain biking in Shindagin Hollow or having a beer at the Chapter House with old friends. But a lot of the time I just want to stay here for a year or so.

I worried before I came that I wouldn't be helpful, that I would order too many lab tests and waste resources, need to ask so many questions about patient care that I would be a time drain on the hospital, and that I would generally be a hindrance not a help to the health care of Lesotho. Maybe it's self-deception but I feel genuinely and increasingly useful now. And that makes me feel SURE that I'll do international health as part of my career forever. I love this. I love being away from home. I love that people laugh at me kindly and respectfully when I try to speak their language. I love the heart-strengthening practice of giving and receiving little pieces of love with gentle touch at the bedside, shared and amused joy at a patient's excellent urine production, and mute but smiley sticker distribution. And I feel so gratified to be learning so much practical medicine here: medicine I wouldn't have the chance to learn in the States but which will be useful when I get back as well. I know that when I start residency in late June I'll feel incompetent again (heh heh) but for now I feel helpful and part of a much bigger definition of medicine than what I left in Boston. Now when am I gonna get that Masters in Public Health...?

OK, I think my cable video is ready.

Thursday, April 16, 2009

Sassy nuns and self-resolving blood clots

Sister Charity came over last night since Scary Sister Lucy was out of town. She wanted us to take full-length pictures of her in her habit and then in her civvies for her "application to 8th grade". Hmm... She had her clothes in a plastic shopping bag and changed and, borrowing my comb, did her hair after this pic was taken.
What's going on here?! You're gonna wear THAT to your first day of 8th grade? She's pulling one over on us and I'm not gonna ask any questions.
A really sweet patient of mine --did I already tell you this?-- came in with what seemed like a blood clot in his leg and shortness of breath that made me think the clot might have gone to his lungs, a pulmonary embolus. We tried to transfer him to Queen II in Maseru, the capital, so he could get heparin therapy (not available here and, even if it were, not monitorable... (not a word)) but they sent him back again because they had run out of heparin as well. Darn. This can kill people. The only thing we had to offer is aspirin but luckily --totally luckily-- he got better and better, got up out of bed and proudly walked around to show me how strong he was getting. He's only 45 but looks quite a bit older. He's pretty wasted from HIV and TB but has good energy and is very close to his son who tended to him for the full ten days he was with us. I was excited to be sending someone home and he was pretty excited to take a photo.
This is my partner in health education this week, Me Lesowane. She and I have been having a good ol' time doing safe sex education, teaching people about the dangers of ignoring high blood pressure or treating it with traditional Basotho remedies, talking through the probable course for patients who have had bad strokes, pushing the importance of anti-retroviral therapy on people who have lived in denial of their HIV status. She rocks and she's like my cultural broker, explaining what I can and can not say to patients, explaining why people are resistant to some of my suggestions and not others, and cheering me on during procedures like my first pleural tap today.

Alright, I'm off up the hill to see if the laundry is done. I have one more pair of undies and I don't think Joe is so lucky.

Swazi pics, German documentation, and spare chicken parts

The Germans!!! Little Simon, Big Detlef, Liz, Hans, Ruth, and Sylvia (? shoot, I forget).
Happy pre-Easter glass with Sister Luvy. Ooh, Kerry, don't look at the knitting in the foreground. It's umm... for someone else and I don't want you to get jealous. I had the computer out because I recorded lucy talking about growing up in South Africa during Apartheid.
Yup, that's a picture of me, alright!

I feel overwhelmed at the prospect of a full recap so I’ll just narrate some pictures from the trip.

Josh swung by the convent Friday morning so Joe and I said “auf wiedersehen” to the Germans and drove down to Little America to find the others. We did a quick passport check, met Libby’s friend, Theresa, and the five of us loaded into the car and headed out, music a-pumpin’ and sun a-shinin’.
Theresa and Libby making final preparations.
Libby had masterminded this whole trip so had the best attempt at directions available by google maps. As many of you may have found out, google doesn’t make a distinction between paved and dirt roads so, instead of driving a couple hundred kilometers over the rocks, we stopped between lovely farms (above) and made an improvised plan. We stopped once for gas and lunch in a little Afrikaaner town. I’m sure there are bright, articulate, kind, even refined Afrikaaners but they don’t live here. So unfortunately, my view is colored by my first up-close-and-personal view of the shoeless, mulletted, old tank-top wearing, harsh Dutch-German accented, first people who –as a group-- haven’t smiled at me in Africa subset of the population. I think I was also weirded out simply by landing in a town full of white people. What are they doing here? Anyhow, they made a decent sandwich so we sat down on some steps on the Main Street that looked like a wild west movie façade and powered on towards the border with Swazi.
We arrived in Mbabane, the capital, just around dinner time. The guide book had recommended "The Mediterranean" for Indian food and, despite how odd it seems to get Indian food at a restaurant called "The Mediterranean" when in Swaziland, we were all goal-oriented. After bunk directions from many sources we found the restaurant closed.
Jazz Friends bar was pumpin' house music courtesy of a DJ on the second floor so the ladies wowed the locals with their moves. The guy in the Kangol hat in the background was seriously slick.
Wildebeesties! A herd of nocturnal wildebeesties!
We woke up in Sondzela lodge to a view we certainly hadn't been able to appreciate the night before. The little hut to the left housed a German.
Hmmph! I want a banana!

Mary ate banana skins (given to her by the employees) and they went down her neck like a snake eating a mouse: totally visible lumps.
Anyone see an interloper? We paid 30Rand (3 bucks) for breakfast of eggs, toast, nasty Swazi porridge, corn flakes, instant coffee or tea, and bananas. The hot stuff was cooked on a camp fire outside the lodge.
I tried to "act big" when Mary got too close to our breakfast food. At first she ran away but she got increasingly bold and habituated to my empty threats.
Read THIS one too late...
This was my preferred position for driving around Mlilwane.
This is about as much hippo as we saw. Occasionally the ears would emerge. I did not feel, umm... in danger of a sudden charge.

Joe dismounted for his final approach to the zebras.
We saw lots of these cuties.
Stopping to appreciate nature and regain circulation to important parts...
Wassup?!
Joe and a big ol' DLC.
Wildebeesties!
Hello! We were about to start up the big hill and were still feeling good, all excited to have seen hippos and zebras.
Stragglers. It was a lot of hill plus there was a lot to see on the way up.
We emerged at the top of the hill to the aptly named Reilly Hilltop Lodge, a GORGEOUS house built in the 1800s by the white dude who made his private spread into the Mlilwane park. The super fancy Reilly Room with private bath costs $100 a night. Hmm... if it weren't for the plane flight I'd come back frequently.
Mrids was tired after "more exercise than I've had in years".
Mrids, Carrie, Josh, Liz, Kat, Theresa, Aude, Libby at the Hippo Haunt after our bike ride. They don't feed the hippos at 3:00 in the winter, we were disappointed to find out. Nice food and drink, though, with a view of warthogs, crocs, fish, spiders, and nice French people who travel with binoculars.
This lady was hanging out just beyond the railing behind us. The body alone was a little under two inches long. I'm really psyched I didn't see any of these in the Sandzela lodge. I don't do very well with spiders.
Local monster at the Hippo Haunt. I'd guess he was ten feet long but Joe thinks I'm exaggerating.
These guys were running around and napping near the Hippo Haunt, our on-park restaurant. The little one was skittish but the big guy was chill.
This guy hangs from vines.
This guy changes colors.
Mary, the feathered beast, wanted to go white water rafting too. This is her pathetic look. We couldn't take pictures of the rafting but it was hilarious. We took a 15-seater van with three guides on a hour-long ride into the countryside, having a dance party all the way. They had some serious bass for their rock ballads and uplifting hip hop in the van and were endlessly amused by our amusement.

We took a dip in the river once we got there, since we had to wait for a second van of people and then the paddles, which had been forgotten. We were definitely on "Africa time" and finally put in to the river maybe two hours after expected. We were all in great moods though. There was an Irish guy named Owen who had just finished school in Dublin and was travelling around my himself. He seemed nice enough but got paired with Mrids and, since neither of them had done this before, they managed to steer with accuracy worse than random and circled and stalled their way along for the first half an hour. I was with Aude and we were doing just fine so got divvied up to move the group along. Own turned out to be impossibly clueless and unpredictably enthusiastic. He paddled hard in one direction when we were already aimed right, he stopped paddling when we got into rapids which is exactly what they said not to do, he panicked and yelled at me when I shifted my weight to get us off rocks, and he repeatedly said "rock" very quietly after we had already hit them. When he said, "I hope I didn't annoy that Indian girl" I responded, "It's OK. She's resilient." He turned around and, looking baffled, said, "Brazilian? I thought she was Indian." I don't think he ever understood what I meant, despite several attempts. I really had a wonderful time, nonetheless. The river was often calm, surrounded by rocky hills, frequented by drinking cows, laundering women, and naked swimming children who especially congregated to see us through the rapid portions. I had never done this before, though I've paddled canoes and kayaks a fair bit. I felt like, in spite of Owen, I could keep us on track for the most part. On one of the moderately fast rapid sections we ended up perpendicular to the flow and both catapulted out of the raft. The guide had told us to ride the river in "cocktail position" dangling your butt and keeping your feet up and in front of you to fend off from rocks and avoid underwater leg injuries. I yelled to a flailing Owen to do the same and down we floated through a fun little section of rapids. For a couple seconds I felt like I was going under a bit too much, but I hit rocks only gently before swimming to the side and hopping in with Aude and Mrids who, by this time, had totally mastered paddling. Owen, by the skin of his teeth and the instructions of strangers, managed to hoist himself into another raft JUST before we hit a big rapid section. Aude and Mrids and I had a blast navigating/succumbing to the river and making it to the bottom safely. The weather was perfectly hot and the lunch that awaited us at the bottom was totally close to decent. We headed back to the park, showered the river gravel out of our undies, and changed for a lovely dinner out.
Kat and Libby opted for the horse-back safari instead of the rafting. That's Kat with a stranger in the background.
I tried to be cool and rejuvinate my African drumming skills from Dartington music camp. Note the spears and assorted hacking sticks in the background.
A dude making hyena benches at the craft market that housed the Swazi Trails adventure office that hooked us up with rafting and caving.
You're goofy.
Oh yeah? You smell like a cave.
Oh yeah? You fell out of a raft.
Oh yeah? You didn't even paddle.
Oh yeah? You got scared by an ostrich named Mary.
Touche...
Buh-GAW! Cock comb and all.

Yesterday I decided it was high time I tried the chicken heads and feet that women cook on little grills in the hospital driveway. So at lunch time, with my vegetarian friend Carrie turning her face away, I purchased two heads and two feet from the laughing cooks for four Maloti (40 cents). Boy, was it worth it! The skin is yummy chicken skin: no surprise. There isn't much meet on the feet: no surprise. But the brains are explosive: quite a surprise. I kept getting mandible in between my teeth so had to give up. Now I know and will never have to repeat the experiment. In the bottom left of the above pic are the omnipresent cheese puffs. They start their lives stale and get worse.

So, now it's back to the patient care realities of Motebang. I've had three really good days here. I have about six patients in the male medical ward and several of them have really interesting problems.