Standing Upright on the Ground

I'm home.

It was indeed rough and rocky traveling, but each time I landed at an airport this summer, there was breaking news footage of a plane that had gone missing or crashed. So while the annoyances felt epic (luggage breaking on the way to Heathrow! 10 hours in an emergency room!), I'm grateful to be safely back in Pittsburgh. It's so nice to come home to my friends, my apartment, and the many familiarities that have shaped my life here.

Tomorrow morning we start our second year of medical school, which feels like a race to the boards in April and clinical rotations in May. But first: a week-long pharmacology class that culminates in a Saturday morning exam.

I will not complain.

I will not complain.

I will not complain.

Why I Love the Internet

My plane from Cape Town arrived at 5:40 a.m. Dubai time, which is 3:40 Cape Town time. After a summer of catching up on rest, this was a rude awakening--literally. But I knew that Dubai Int'l had a free lounge for travelers with long layovers, so I anticipated a decent rest.

The only catch is that the Emirates staff will wake you up should you "accidentally" doze off in the lounge. Particularly if you do so curled up on a couch, using your jacket as a blanket.

And so it was that I googled "sleeping Dubai airport," which led me here, and onto the lounge chairs near the departure gates. Essential information for poor students! I am now semi-rested, and with a free Emirates lunch to boot. There were even fresh fruits and vegetables involved.

Now, if only "Cape Town haircut" had been a little more fruitful . . .

Ubuntu*

"I am who I am because of who you are." This is the phrase we repeated at the festival celebrating Mandela Day, and it seems fitting to share it on my last day in South Africa -- at least for now. I have learned so much from the people I have met here, from the health care professionals I interviewed, and from the patients whose stories they told; from small moments at markets and on the street; and from the friends I have made. It has been a privilege to talk to South Africans about their life in this very new country, still beset by poverty and social ills, but filled with people working to improve the lives of their fellow citizens. I'm honored to call some of them friends.

Yesterday was my last day at the office, where I had a series of warm good-byes and thank-yous. My friends there bestowed upon me enough UCT gear to last a lifetime, and a vuvuzela, the horn blown by SA soccer fans. There was lunch, there was dinner, and today there will be some last-minute hanging out and a much-appreciated ride to the airport.

And then I'm off, to London via Dubai. It's been as long as six years since I've seen some of my UK friends, so there is a lot of catching up to do! When I get back to the States, my brother will pick me and we'll spend some time with our mother. It will be the first time the three of us have been together since last December! And so while I'm sad to leave Cape Town and the friends I've made here, I am so looking forward to the next few weeks of reunions.

***

The other day, I was driving on the M3, a highway that circles Table Mountain and affords postcard views. It was a typical Cape Town day, raining on one side of the mountain with warm sun a few kilometers away -- dramatically gorgeous. I was struck by the lyrics to "Till I Gain Control Again," a song I've heard again and again, but it sounded new to me at that moment.

No matter what sea I've been sailing on, I'll always roll this way again.

So whether I come back here (yes please!), or my South African friends come to the States (yes please!), or we meet again elsewhere in this small world, I trust that the relationships I've built here will continue to grow in the years to come.




The nicest place I've ever had lunch -- atop Table Mountain after a three-hour hike.








*The wikipedia page on ubuntu is pretty interesting, with great quotes from Mandela and Archbishop Tutu. It sounds like parts of the Obama administration have actively embraced ubuntu, as have the Boston Celtics.

These friends of mine

I have been blessed throughout my working life to have had wonderful colleagues and mentors; my office in Boston was like a second home, filled with people who really celebrated each other. Some of my most important connections were forged there.

My coworkers on the campaign were the warmest group of people I've ever known. A friend, who joined us midway through, remembers thinking, "who are these hippies who keep laughing and hugging each other?" The office here continues my good luck streak, with nice, smart, funny people who are brightening these data entry days.

My friend Emma has taken me up Devil’s Peak, out for a day trip to the winelands, and on various impromptu lunchtime trips around Cape Town. She has lent me books, made me crunchies (faux healthy cookies), and welcomed me into her life with great warmth. On our way to the winelands, we got lost on a detour and ended up in a suburban housing development, turning down streets that were indistinguishable from each other. Her husband, who was driving, was cursing under his breath; Emma, meanwhile, pointed out the window and said, “look at that rose bush! Isn’t it lovely! And out of season, too! We never would have seen it if we hadn’t gotten lost.” She's no naif, and no stranger to the words that were escaping her husband's mouth, but she was dead serious at that moment. It disarmed everyone in the car.

There too is my friend Liesl, who is passionate about the new South Africa and reconciliation. She actively refuses to be defined by her race, not avoiding any area just because outdated laws have lived on in spirit. And so she has brought me all around the Cape Peninsula, taking me to festivals, comedy shows, hole-in-wall bars, and aimless rambles everywhere from the townships to the ritzy Southern Suburbs. Any time you thank her, she responds with “pleasure!” in the most exuberant voice. It makes me want to thank her all the time.

Linda, who brought me to Khayelitsha a few weeks ago, is a force of goodness. She reminds me of a Gregory Peck quote, about how he woke up every morning trying to be a little more like Atticus Finch: the world would be vastly better if we were all a little more like her. Her work, which considers as somewhat separate from her job, is to heal the spiritual sickness brought on by HIV. She’s not referring to faith healing, or alternative medicine -- she’s talking about addressing the profound sadness that the epidemic has brought to the country. Last week, she brought a room of nurses to tears during a session on the spiritual care of orphans; watching them thank her was a spiritual experience in itself.

I could go on with anecdotes about the people I’ve met, but I’ll close by telling you about my friend Sharon. Another generous and hospitable South African, she regularly invites me over for meals and teas. I say this to highlight her genuine kindness. Upon arriving at a party a few weeks ago, she scanned the crowd, looked at me, and said, “Ahhhh . . . I’m certain that at least 80 percent of the people in this room are narcissists.” I really like her.

Toi-toi

1. South African for riots or protests.

2. Near-daily activity since I've been here.

Today's toi-toi is brought to you by all public transit workers. This means no buses, trains, or service delivery, plus abundant warnings against going into the city center. Not to worry: I'm safe in the Ivory Tower, entering what seems to be an endless amount of data.

Mzoli's: it is what it is

Yesterday some friends took me to Guguletu, one of the black townships in the Cape Flats. There is a famous-ish restaurant called Mzoli’s, where you pick out your meat and they braai it for you. The meat comes with samp and beans and mealie pap, which looks like overwhipped institutional mashed potatoes. For about $20, here was our spread:


Note that there are no utensils, which was interesting.

The food was amazing.

The owner was lovely and solicitous.

The music was loud and good, and the people danced at their tables, in the streets, and in line for food.

After lunch, we went around the corner to a shabeen, an unlicensed tavern. It also seemed to be a hair salon, which was a little confusing. There was a big rugby match on—the SA Springboks played the New Zealand All-Blacks, a longstanding rivalry. We/they won! And I had another moment where I wondered what my life would be like here. Is Jaque Fourie the new Tom Brady? Could coach Peter de Villiers ever take the place of Bill Belichick in my heart? Just as with Belichick, De Villiers’s press conferences are an awkward tour de force. He mumbles in thickly accented English and it’s generally accepted that no one can understand him. He smiles the entire time, though, which does distinguish him from BB. He also wears a ridiculous formal jacket, which I suppose is the South African equivalent of the hoodie.

When I tell South Africans that I flew from London on the same plane as the victorious post-World Cup Springboks, they curse me for not knowing who they were. Now I’m cursing myself for wondering “which local soccer team is sitting in business class.” Alas.

In December, there will be a movie about the 1995 World Cup, in which the Springboks played the All-Blacks in South Africa. It’s really the story of Mandela and how he used the traditional Afrikaner rugby as a tool of unification. John Carlin, a British journalist, wrote the book on which the movie is based. It was surprisingly powerful. Read it.

Wrapping up

After Kruger, what more is there to say? Most of my time has been eaten up with data entry, not exactly the most blog-worthy activity. I went to a comedy show last weekend, which on top of being lots of fun, taught me a lot about South African politics. The country also observed the first Mandela Day on his 91st birthday last Saturday. There were festivals and impromptu parties around town, although Mandela himself asked for each person to give 67 minutes of service--a minute for each year he spent as an activist.

On Monday, I climbed Table Mountain proper in lieu of working. It was a perfect day, and from the top you can turn around and see down the Cape Peninsula, out over the Atlantic, and out to the Winelands. While we didn't get lost, I wouldn't say that we took the most direct route home. "I think my muscle is breaking down," my fellow hiker said the next day.

I did make it back out to the Winelands, where I conducted interviews, ate well, and thought of never leaving. It is beautiful there, and the weather is autumnal--it reminds me that I'll come back to a month of summer* and then fall, with its cool nights, foliage, and fresh apples. It's nice to look forward to coming home, although I am getting sad about leaving. It's been a lovely two months.

One week to go! Today is an informal township tour, courtesy of my friends who actually live in the townships.

*apologies to Bostonians.

Lions (but not tigers and bears). Oh my!

For some unknown reason, several of my friends have invoked the words of the late, great Judy Garland in response to my trip to Kruger National Park. While I don't think anyone said "oh my," there was certainly a lot of "wow!" on our truck.

The tales of this trip are best told by photographs, but I will relay some of it here as well. My trip consisted of a young British zoologist, whose helpful presence was most welcome; a rockin' mother-daughter pair from Australia; and a very unsettling Canadian man from Bulgaria. Our guide, Jafta, was a prince. He has been married for 25 years, but wasn't able to afford a wedding until he started working for Funky Safaris a few years ago. Last year, he gave his wife and four children a 300-person wedding in their village. I will shamelessly plug Funkys to the death for the good work they're doing in the area, including good pay for their staff.

The best experience came towards the end of Saturday. As it turns out, being on safari is exhausting; you're bouncing up and down in the back of a truck, and concentrating so intently on the side of the road. It's freezing in the morning and at night, so your muscles are tense from staying warm. It is also a long day, starting at 5 a.m. and going into the early evening. By the time we started heading back to the camp around 5, we were all struggling to stay awake. Then we came across the elephant crossing the road. This is not the beginning of a joke.

The first elephant was soon followed by another, and another, until it became clear that a family of some sort was traveling together. One elephant served as a crossing guard (or lollipop lady if you're an Anglophile), while another stood guard at the first car in line. At some point, a minibus got tired of waiting and decided to drive through.

Over lunch, Jafta had told us that before an elephant attacks, it gives three warnings: shaking its head and trunk, roaring, and finally taking one step backwards before charging. Sure enough, the elephant standing at the first car took all three steps before lurching towards the minibus and its shrieking passengers. The elephant stopped after a few steps, returning calmly to his previous post, and the minibus got away with only a scare -- and the disdain of the other humans in the area.

Here is a list of the animals we saw, in approximately the order we saw them. (Yes, I took notes.)

impala (either one male: five females; or bachelor herds, which the zoologist said were the ones "who can't get women." Ha!)
water buck
white rhino
elephants
giraffes (including two pregnant ones)
mongoose
lions
zebras
wildebeest
warthogs
kudu
hippos
African fish eagles
kingfishers
bush pups
baboons
goliath heron
grey heron
darter
tsebe
and . . . not a single mosquito!

Bono was here

The picture I had in mind as we headed out to the children's home and hospice in the township was the one I had seen on the internet: Bono (in red sunglasses, of course) holding a very young AIDS patient. Sure enough, that picture was in the office, as well as a wall of pictures of sports stars who had visited. I'm often skeptical of stars and the places they visit, but this place was extraordinary.

First, though, I should tell you how we got there. While I've been driving all over the metropolitan area for interviews, my site mentor insisted that I go accompanied by a (black) social worker. There is so much I could say about how race works in South Africa. What you need to know for this story is that the apartheid government divided townships into black and coloured (mixed race), and this is a black township. It is recommended that you visit the townships with a local, or at least someone who looks like a local. And so it was that Linda and I set out this morning for Khayelitsha.

Another story about race: one of my friends here wants to take me to a snoek braai* in a black township. She is coloured, but under apartheid her family members were classed as white, coloured, black, and Indian, depending on where they lived. She said that she will call her black friends to see if some of them can accompany us. It would be okay if she went on her own, she explained, but my clearly white presence demands an escort.

Back to this morning: we get off the highway a few miles from the hospice, and the secondary road is filthy beyond anything I've ever seen. There is trash piled up on the sides of the road, and as we near the hospice, the trash starts to show up in the middle of the road, then in the driving lanes, so that you have to wait for oncoming traffic to pass before you can drive. The streets are also lined with people, as though a parade might show up in the midst of the garbage.

Three police cars drive by with sirens wailing. "I hope they're going somewhere important. Sometimes they just want to get around the traffic," Linda says, by way of explanation.

"Police in America do the same thing," I say.

"They do?"

Now there's a dumpster in the middle of the road, turned over, with trash spilling out. We encounter several more until we get to the road we need.

We take the turn to the hospice, and there are about dozen police cars blocking the street.** Linda asks out the window for directions and a man jumps in the back. I'm not sure what's going on; they're speaking Xhosa, of which I understand approximately 20 slowly spoken and well-enunciated words. But they're laughing, so I assume everything is fine. The detour means another 5 minutes of driving through the dirt roads of the township, which are packed with people, including kids who play chicken with the car. Outhouses and collapsed homes line the street.

The man -- a hospice employee, as it turns out -- brings us in so that I can do my interviews. Afterwards we get a tour of the compound, which includes an orphanage, a health training centre, and a school. There are at least a hundred children in the orphanage, and when we go in, some of them start climbing on me, using my dress and bag as a rope and ladder. We can hear shouting and sirens in the background, but the kids are just being kids. As we chat with the staff in one house, the kids spontaneously break out into a loud song-and-dance that we soon recognize as the English alphabet. I put down my bag in the 2-3 year old house, and turn around to find one boy rummaging through it while another tries to carry it over his shoulder.

There are very few places in the area that care for children, so this home is unique just by its mission. What made it more unusual was the respite centre, where HIV patients could spend 6 weeks getting on antiretroviral drugs, regain strength, and receive care that their families were unable to give. Beyond that, the centre trains locals to be home-based carers (community health workers, accompagnateurs, caregivers) for AIDS patients, and maintains a full school for its kids. On top of the large staff, there are volunteers from around the world who come and live there for a year.

We walk back to Linda's car and smell tires burning. A police helicopter hovers nearby, lowering a rope. The kids are going crazy at the gate. The helicopter is beyond exciting to them, and they're trying to get out to go see it. "I'm gonna climb it," one of them tells me, jumping up and down.

The whole scene was mad, but my tolerance for disorder is unrecognizable after five weeks here. I'd been told that sometimes doing a summer project abroad is just about learning to cope in a different environment. I've been fortunate to find my work here fulfilling and interesting, but I've learned a lot just by being here and interacting with other people. So now I know to tip the guy who sits near my parked car because he'll guard it; that I have to leave room at red lights in case I need to get away suddenly; that red lights are in fact just a suggestion; and that in the right company, I am not only safe, but welcome anywhere in the area.

Driving alone, I think I would have turned around at that first dumpster and opted for phone interviews. What a loss it would have been for me.

* an elaborate fish bbq
** it turns out that the citizens are protesting the lack of municipal services, starting with the irregular trash pick-up. In another part of Cape Town today, the taxi drivers ended an unrelated protest with rubber bullets from the police, possibly in response to actual bullets from the taxi drivers.

Recent highlights

*Hiking Devil’s Peak (1003 m) on a beautiful sunny day, breathing in the clouds at the top, and looking down the Cape Peninsula, east to the snow-capped Franschhoek mountains, and west to Robben Island. As I looked behind me to the trail we had taken up the mountain, I saw the Southern Suburbs (L), and as I looked ahead to the route down the mountain, I saw the city bowl and Table Bay (R).











*Discovering Maharajah, a fabulous and dirt-cheap vegetarian Indian take-away. They are known for “bunny chow,” in which they fill hollowed-out bread with a curry dish. Legend has it that the dish came about during apartheid, when non-whites were not allowed to sit in restaurants, requiring portable dishes served through back doors. They also have the nicest owner, who has posted numerous articles about the ethics and environmental impact of eating animals; it's pretty harsh reading for a restaurant wall.


*Going to Robben Island (in part inspired by seeing it from the mountain) and hearing the story of Mandela and his fellow political prisoners. All guides on the island are former political prisoners, and so they use their own stories to tell the history of the island. It was so powerful. Below is one of the cells that housed multiple prisoners, and to the right is the prisoners' menu, segregated by race.





*Seeing the sun rise from Signal Hill, yet another amazing viewpoint along the Table Bay shoreline. An artist was there too, and he called the guinea fowl over so that I could take a picture. Happily, my fear of birds is ebbing.

*Day trip to the winelands: beautiful view, lovely, creative food, abysmal service--as in, we waited 90 minutes to get our food. We consoled ourselves by watching glass-blowing and climbing goats.

*Coming across a Michael Jackson dance memorial. Unfortunately, I had left my camera at home, but it was covered on the news.

*The Woodstock Neighbourgoods Market, an interesting two-mile walk from my flat. It’s one of Cape Town’s many markets, but the only one I know of that focuses on local farmers, as well as local crafts and young artists (see the pillowcase on the left). Mostly I went because I heard the food was outstanding--and it was! Here are some of the delicacies we sampled: raw chocolate, goat cheese (vanilla, oak smoked, chili, olive), goulash, smoked olives, goji berries, raw muesli, Dutch almond cake baked onto a spice biscuit, rye bread with olives, raw honey with hazelnuts, Moroccan harissa, avocado almond pesto, almond rocket pesto, bacon-wrapped mushroom kebabs, and a fresh spring roll with butternut squash, pineapple, and smoked chicken. We bought the last two items once the guilt of free samples became too much to bear.

*Going on pain rounds at a pediatric hospital. Admittedly, it's not in keeping with the touristy nature of this post, but it reflects how I spend 5/7 days--just not the picturesque ones. It was heartbreaking and a powerful motivator to do my small part to help.

*Booking a two-day safari to Kruger! In the meantime, lots of interviews this week, and some local traveling. Hope everyone enjoyed their holiday weekend.

Where I'm actually from

For eight (very specific) years, when traveling abroad I would occasionally tell people that I was Canadian. It wasn't always an apology; more often it was a way to defuse the conversation with a stranger. I didn't always feel like carrying the weight of such a powerful country on my shoulders, particularly not while browsing at markets or renting windsurfers. I wasn't alone: one friend put a Canadian flag on her suitcase.

Of course, my relationship to our northern neighbor was more complicated than just a few white lies. In both 2000 and 2004 my friends and family threatened to move to Canada. One of the best weekends of my life was in Toronto. And I have a persistent and rather romanticized notion that Canada is more civil, more humane, and happier than the U.S.

By that measure, yesterday brought the email I have been waiting for:

"Hi Signe, It was a pleasure having you . . . I also wanted to know whereabouts in Canada you are from. "

But this year feels very different. South Africans are keen to know all about Obama; my office mates have pictures of his inauguration above their desks. I'm proud when I talk about his election and what it meant to me and my friends. I'm not a flag-waver by any means, but I am not Canadian today, either.

Happy 233rd.

Where are you from?

"The States."
"Yes, I hear your accent. Where in the States?"

At this point, I have a choice: Boston or Pittsburgh. My friend's husband, an architect, was one of the few who got "Pittsburgh" as an answer. To my delight, he not only knew of Pittsburgh, but actually said, "have you been to Fallingwater yet?" More typical is my interaction with a street vendor, who was wearing a Steelers parka:

"Oh! I'm from Pittsburgh!"
"I'm from Harare."

And so I've said "Pittsburgh" to enough blank stares that I usually just say that I'm from Boston.

It has yielded a few good responses:

"Is it snowing there now?"
"No, it's actually summer now."
"So it snows less?"

"Do you hate the Yankees?" I'm glad to see that globalization applies to the Red Sox -- including the Coco Crisp jersey I spied the other day at the grocery.

Bad, bad -- really, really bad

In planning out my study for this summer, I defined my project in part by the questions I wasn't asking. Things like pain managment training and cultural issues ("We're poor/Xhosa/coloured. People like us suffer. Rich people get medications.") will need a different sort of investigation, and this was anticipated to one degree or another. But yesterday it was brought to my attention that a new question arose last week.

"The Michael Jackson thing is going to set us back. People are going to be afraid of opioids again," said a pain specialist. Now, there's a lot that can and has been said about MJ's death, but this was the first time I had thought of how it might impact medical care. Christian Sinclair, who writes about palliative medicine in the new media, had a post or two about it as well.

What a tragic legacy it would be if his death erected yet another barrier to pain management for people who need it.

Go Pens

Yesterday was the best day I've had since getting here. I feel like I'm hitting my stride with the interviews, and having a car to explore has been a real treat.

I spent the morning in Fish Hoek, interviewing the interdisciplinary care teams (doctor, nurses, social worker, chaplains--hello Mariska and MB!) about their experiences with pain control. They were really helpful and I learned a lot about some of the system barriers that are preventing optimal pain relief. And while I'm not actually sure where my medical career will take me, I do know that I have huge amounts of respect for the team model that I've seen in palliative care.

I took the combination of a productive morning and some good weather as a sign that I should spend the afternoon exploring, which I did. How much do I love summer research?

I ate here:


And then went down to Boulders Beach and saw the penguins:



If my commute home looked like this every day, I'd be pretty happy:


I ended the day with a fantastic sushi dinner with E. and her daughter. We availed ourselves of all the seafood Cape Town has to offer. Oh, and I had springbok sushi. It was pretty amazing.

Next up: hiking Table Mountain in the morning with officemates. The weather has promised to cooperate this time.

Dozen

For some time now, and with increasing frequency since coming to Cape Town, I am asked how I came to be interested in palliative medicine. I usually answer by talking about my time working in social medicine; it is true, it is accurate, but it is wildly incomplete.

The full truth is this: half a lifetime ago I sat on my father’s hospital bed while his surgeon told us that they would both do everything they could, but that their primary goal was to keep him comfortable. It’s the last time I remember my father being fully cognizant, although he lived for another year and a half. In that time he underwent surgeries, radiation, chemotherapy, and was on a cocktail of drugs to prevent seizures and reduce the swelling in his brain.

Hospice became involved at some point, although it was for longer than the insurer-prescribed six months. We learned how to guide him as he lost his sight; and tricks for delivering medication. I remember having coffee with a chaplain and not knowing what to say, how to make sense of what had happened to my life. And I remember our community coming together as an informal care unit, keeping our freezer filled with dinners and providing rides to school and to doctors’ appointments. And I remember my father’s physicians, how attentive they were to us, how they bore witness to our pain and confusion throughout the process.

These are experiences of illness that work against suffering, but supportive care alone provides little relief in the face of physical discomfort. And so the physicians tended to his body as well his family. To the extent that medicine could provide relief for him, it did. We were lucky in this regard, as my father’s symptoms were mostly cognitive, and he suffered negligible pain. As a family, our suffering was great, but essentially limited to the personal and spiritual realms. Suffering beyond that—from poverty and inequality, for example—is beyond my imagination.

So how did I get here, working to improve access to palliative care drugs in rural South Africa? Experiencing the effects of good palliative care, before I even knew the term—that’s a good starting point. But it’s hardly a straight line from my family’s experience to here; years of education, formal and otherwise, have intervened to shape my goals. I’m here in part because of a genetic sense of social justice, from my conscientious objector grandfather, to my father, who marched against Vietnam in his dress whites, and my mother, who came out in the cold New England winter to knock on doors for Barack Obama.

***

Today is a dozen years since my father died. I have mixed feelings about it – after all, until 1997, June 24 was nothing but an early summer day. And then it became a marker in my life, a place to orient a before and an after. As each year has passed, I have been able to see more clearly the role my father’s death played in shaping my life. At one year, I was lost; at five years, I was found, and beginning to think about a future of some sort; and at ten years I was writing my application essays for medical school. At twelve years, I’m here, in an office thousands of miles from home, on an ordinary workday. In many ways, I’m worlds from a life with my father, but at other times I can conjure his encouraging voice. I know he would be proud of me—he always was—but sometimes I’d trade anything just to hear him say it one more time.

From the people who brought you the weekend

Today is the first day of a doctors’ strike in South Africa. Having not received a 50% (that’s right, fifty) pay raise from the government, they have taken to the streets in protest in several provinces here.

It blows my mind that doctors can go on strike; who’s taking care of patients?* Of course, it's not unheard-of: when the U.S. government shut down in the 90s, my physician uncle was working part-time at a VA hospital. If I recall correctly, he didn’t go to work at the VA during this time; at the very least, I know that he wasn’t paid during this time. It wasn't the same thing—certainly it came from a very different set of circumstances, but it's the only time I can recall doctors actively not working.

I just saw an intern (first-year doctor) interviewed on the news, and he explained how the current system made it difficult to do his job: "the conditions are terrible . . . patients are dying all around you. Last week there was no oxygen in the hospital . . . there was no water for two days." He also revealed his salary: 8,000 rand/month, or $12,000 a year. Pay increases as you progress through training, but not by much: a senior general surgeon with 15 years experience quotes his salary as $28,500.

There are two systems for health care in South Africa, one public and one private. The private system is similar in many respects to the U.S. system, with insurers (called, hilariously, “schemes”) paying for a portion of medical care. Most patients are in the public sector, however, which is notorious for overcrowding and poor conditions. Public physicians make far less than their private counterparts, and they work well beyond the 80-hour workweek that has been imposed on U.S. medical trainees.

Usually I stand with the workers—but these are doctors.

And usually I think doctors who complain about money are jerks—but that’s in America.

I know it’s more complicated than this, but South Africa would be wise to give the doctors what they’re looking for. It means standing with the patient, the 80% of South Africans whose already-precarious healthcare is at risk.

You can read more here, here, and here.


*Nurses, as always. They’re also bringing in private sector doctors for relief.

To the left, to the left

Not much to update on today -- just preparing for interviews, which start tomorrow.

I am renting a car to get myself from hospices to hospitals to Department of Health offices, and I am uncharacteristically nervous about driving. I have been adequately warned about the maniacal South African drivers, and to stay to the left; however, the fact that I thought my friend was taking me the wrong way down the street does not bode well. Wish me luck!

On an entirely unrelated note, I wanted to share this, courtesy of a fellow palliative medicine person. I feel that I'm minimizing its impact by telling you that it's Roger Ebert (he of the famous thumb) reflecting on his own mortality. It is well worth reading.

Exactly

Today I called the hospices in Cape Town to make appointments for interviews. Here is an excerpt from one call:

me: blah blah blah to look at the availability and usage of opioids in HIV-positive patients receiving palliative care.

her: I don't think you would get much from coming here. We haven't had opioids in three years. Our nursing sisters wouldn't know about it.

I checked the number on the sheet to make sure I was calling the right place--I was.

Then I double-checked by looking at the map--it's about 6 km / 4 miles away from the university. To get there, I'll pass the President's Residence, turn at a Mercedes dealership and "keep an eye out for the sign on the left."

How to stay safe in Cape Town

Classic and frequently repeated advice from guide books and Capetonians alike, found at a bus stop on my block:


It's part of a larger display, explained here:

Holiday in Hermanus

One of my classmates told me that Cape Town was “just like Pittsburgh!” Now, I love my adopted hometown, but this was not encouraging. I had hoped to travel halfway around the world to find something different for a few months. We do share championship sports teams and lots of hills, as well as an alarming love of mayonnaise and French fries. However, my friend was referring only to the weather. Every day there is a chance of rain, and more days than not there is some precipitation.

Today the forecast was again cool and rainy, but I woke up to a beautiful sunny day. It’s Youth Day, a national holiday commemorating protests by schoolchildren seeking equal education during apartheid. As far as I can tell, it means no one works and big box stores have huge sales. Fortunately, I had other plans.

E., my site mentor took Camilla and me to Hermanus, a coastal village east of Cape Town that promotes itself as the best place in the world to whale watch from land. We saw zero whales but two baboons and several dassies. They look like rabbits but are most closely related to elephants, and they enjoy "sunning themselves," as my Rough Guide informs me.

We ate lunch overlooking the water and walked around for an hour or so afterwards. It was a beautiful day, and a treat to see a different part of the Western Cape. As it turns out, actually, I’ll be doing some exploring for the project as well. E. and I decided that I should travel to the hospices to interview people, instead of using the phone. This is great on so many levels: I won’t be in an office all day on the phone; I’ll be driving around the countryside; and I’ll get to actually see what’s happening “on the ground.” My first interview is scheduled for next week.

More pictures from Hermanus are below.

Weekend II: rain-outs and World Cup construction delays

Yesterday we were greeted with the worst possible weather in which to scale a mountain: rainy, cold, and thunderstorms in the distance. So while we saw the bottom half of Table Mountain from various vantage points, we limited our exploring to the city proper. Camilla (another visiting student) found a tour guide through the NGO we’re working with, and he drove us in and showed us around the remains of District Six and its museum.

District Six was an integrated, working class neighborhood in Cape Town that was declared “whites only” by the apartheid government in 1966. The neighborhood was demolished, and the black and coloured residents were sent to live in the Cape Flats, 40 km away. The townships out in the Flats are filled with shanties and lean-tos, and the area is rife with gangsterism. The museum commemorates the neighborhood with interviews, artifacts, and artworks from the citizens. It was quite a moving experience.

Today the idea was to find the Green Point Market, but it has been displaced by the construction for the World Cup 2010 – starting in less than one year, as I hear several times a day. It took us about an hour of walking to find it, at which point we were too tired to walk around , so we caught a minibus back into the city and had lunch. Our guide picked us up and drove us down to Chapman’s Peak, just south of the city. There's not much to say about it, but the view was lovely:

C. and Leon walking around Chapman's Point. The Sentinel, the peak seen in the distance, is privately owned and up for auction. You can't develop it, and the owners expect to get about R12 500 000 (~$1.5m). Any takers?