Hey everyone! I know it's been quite a while since I've written, but due to all of my competing responsibilities (rotations, exams, interviews) I don't have the time to devote myself to this blog the way I would like. However, I do have an exciting announcement!
This spring, I will be returning to South Africa! For approximately six weeks, beginning in early March, I will be working with NetCare911, South Africa's biggest pre-hospital care provider. I will be based in Johannesburg for the majority of my stay, conducting research on flight medicine and its utility in trauma. This means I will be flying as part of the aeromedical crew!! (me = incredibely excited). This is, in may ways, a once in a lifetime opportunity that I'm really looking forward to.
My return to South Africa, of course, means my return to writing this blog! And I will be bringing along my camera, so I will also be posting more photographs. Thanks again for reading, and please check back in March for further reflections and random musings from (that's right) elsewhere. And otherwise. (I had to, I just had to...)
Monday, October 13, 2008
Sunday, June 8, 2008
Back!
It's been nearly a month since i've gotten back to the states, and after some thought I have decided to continue writing... at the very least, writing down my thoughts and experiences once a week or so will keep me on my toes :). I'm on a Surgical ICU rotation right now, at NJMS-Newark (it's a trauma ICU, so for the moment that's keeping me very busy...), but i'll be able to get back to a more regular schedule of writing in a few weeks. For now, I wanted to share a few poems that I wrote while I was in South Africa... the first deals with the inevitable love (what's a chick website without at least one love poem, right?) and the second... well... you can figure it out. Thanks for the reading, i'll be back online and writing shortly!
Oh, and I also wanted to let everyone know that I have new photographs of Soweto on my photography site... just go to www.pbase.com/quideam.
US
A moment with you
And I'm lost.
An eternity runs past
And I do not notice.
Time
It pulls you away
Too suddenly
Too quickly
But a moment with you
And I'm lost.
Time cannot seep
Into us.
SORRY
I bleed for you,
Dark crimson pouring out.
Contractions clutch my soul,
And shove it down my throat,
And on the floor.
And there it is.
I look down and it's you.
My insides are outside,
Coffee grounds and tomato paste,
Salt water and crushed ice.
I'm bleeding with you,
Drowning in me.
And then you're gone.
I wasn't ready yet.
I'm sorry, my child, I wasn't ready yet.
Oh, and I also wanted to let everyone know that I have new photographs of Soweto on my photography site... just go to www.pbase.com/quideam.
US
A moment with you
And I'm lost.
An eternity runs past
And I do not notice.
Time
It pulls you away
Too suddenly
Too quickly
But a moment with you
And I'm lost.
Time cannot seep
Into us.
SORRY
I bleed for you,
Dark crimson pouring out.
Contractions clutch my soul,
And shove it down my throat,
And on the floor.
And there it is.
I look down and it's you.
My insides are outside,
Coffee grounds and tomato paste,
Salt water and crushed ice.
I'm bleeding with you,
Drowning in me.
And then you're gone.
I wasn't ready yet.
I'm sorry, my child, I wasn't ready yet.
Thursday, May 8, 2008
Happy Birthday
Yesterday was Israel's 60th birthday, marked by numerous celebrations commemorating the nation's struggle for independence in 1948. I wrote a poem (posted below) to commemorate the continued struggle towards a truly democratic, peaceful nation that can be celebrated by all of Abraham's sons and daughters.
Birthday
Toddler in men's trousers,
Sucking your thumb through a cocked pistol.
Is the trigger in your mouth?
But you're pointing it at me.
Ancient stains on a tainted land -
Did He keep His promise?
Birthright through bloodshed,
And no one to tell the emperor he's naked.
The keys to the temple are here,
But we search in darkness.
Where did we meet last we found each other?
Take my hand, my brother.
Sixty candles coated in honey,
But the milk is burning.
Can you see?
Can you see me?
Birthday
Toddler in men's trousers,
Sucking your thumb through a cocked pistol.
Is the trigger in your mouth?
But you're pointing it at me.
Ancient stains on a tainted land -
Did He keep His promise?
Birthright through bloodshed,
And no one to tell the emperor he's naked.
The keys to the temple are here,
But we search in darkness.
Where did we meet last we found each other?
Take my hand, my brother.
Sixty candles coated in honey,
But the milk is burning.
Can you see?
Can you see me?
Tuesday, April 29, 2008
Night
5 am and we're hurtling through the streets of Soweto. Brush fires blaze in the background as shadowy figures huddle around them for warmth, thick blankets wrapped tightly around thicker waists, infants rocked to sleep on their backs. Bitter whiskey runs freely between young men patrolling the streets with bats; barely old enough to shave, they are marching with an uneasy certainty. Metallica's "For Whom the Bell Tolls" blasts from our radio. I open the car window as Francois lights another cigarette, and the wind is deafening.
'Princess' is a squatter camp rocking on the edge of chaos; it is a place of cramped shacks, raw sewage, and bullets. I wear an over sized bulletproof vest over my jacket, aware that its frayed belly is more for show than any real protection. Francois offers me a hand as we pass over a rickety bridge haplessly built on an open sewer; I do not need it, it is not the first time that I have passed through nightmares. Quietly, we make our way to a tiny shack, barely the size of a western bathroom, nestled in the heart of the camp. There is no crowd, only a small girl standing outside, lost in a dark blue blanket; a fat officer with faraway eyes idles restlessly nearby. We walk inside. There is a woman sitting on a bed. She is young and frail with high cheekbones and slightly sunken eyes; she clutches a bottle of milk and doesn't look at us. Her three month old daughter is lovingly wrapped in a blanket beside her, tiny coarse curls matted against her forehead. She wears a tiny pink hat that nearly covers her eyes, startlingly long eyelashes peeking out. We stay only briefly. We don't talk to the mother. As we leave, we ask the officer to translate for us. "Please tell her that the baby is dead", we say. We file a report and leave, drive away, faster and faster in the darkness. Far in the distance, beyond the dry hills and isolated roads, Soweto is burning.
I have written a lot about God in this past year, generally to reflect on his absence. The problem of evil haunts me: how could a benevolent God allow the horrors I see all around me? Perhaps worse, how could he blind so much of the world to the suffering that is so obvious it shakes me to the core, keeps me awake at night? There is so much pain, and for what reason? For a long time I have not believed in God. Rabbi Hillel said that most people live their lives in an easy darkness, unaware of their blindness. A few, however, are tormented by lightning: occasional flashes of realization that light up the earth and shake them from complacency. My experience this year has been one long lightning storm; sometimes it is a nightmare that I cannot wake up from, but other times I'm glad, because I am no longer sleeping.
I suppose that it would have been easy for God to make people good, to always make the right choices and create a happy world. But instead of goodness, God gave us an even greater gift: he gave us freedom. Uniquely, we have the ability to analyze and reflect, thereby making genuine choices. Those decisions will not always be right or just, and humanity as a whole has suffered for it. Greed, hatred, bigamy, ignorance... they plague us as a people, and yet most of the time we continue to walk in darkness, blissfully unaware of the evil we have allowed ourselves. But God in his wisdom has in fact given us two gifts: Free will, and Insight. I believe in God because I have seen the lightning; I have felt the truth and am blessed with the ability and opportunity to bring change, however small. It is a challenge that we all must answer, each in our own way. My time in India and Africa has been illuminating... I am coming home with enough thoughts to write without stopping until the end of my days. There is so much to see, to do, to experience and to change that it is nearly overwhelming... I take deep breaths and continue on, small steps and one at a time.
Thank you to everyone I have worked with - all of the amazing people and organizations that have made this year possible. You have enriched my life beyond belief, and I hope that in the years to come I prove worthy of the opportunities you have granted me. I have two more weeks in South Africa, mostly on holiday, but I will continue to write. After all, there is so much more to say. I am sitting here now, listening to the familiar Metallica tune that blasted on the radio a few nights ago in the paramedic response car. The deafening instruments do not drown out the original inspiration, Jon Dunne's 16th century poem in which he famously wrote that "any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee."
'Princess' is a squatter camp rocking on the edge of chaos; it is a place of cramped shacks, raw sewage, and bullets. I wear an over sized bulletproof vest over my jacket, aware that its frayed belly is more for show than any real protection. Francois offers me a hand as we pass over a rickety bridge haplessly built on an open sewer; I do not need it, it is not the first time that I have passed through nightmares. Quietly, we make our way to a tiny shack, barely the size of a western bathroom, nestled in the heart of the camp. There is no crowd, only a small girl standing outside, lost in a dark blue blanket; a fat officer with faraway eyes idles restlessly nearby. We walk inside. There is a woman sitting on a bed. She is young and frail with high cheekbones and slightly sunken eyes; she clutches a bottle of milk and doesn't look at us. Her three month old daughter is lovingly wrapped in a blanket beside her, tiny coarse curls matted against her forehead. She wears a tiny pink hat that nearly covers her eyes, startlingly long eyelashes peeking out. We stay only briefly. We don't talk to the mother. As we leave, we ask the officer to translate for us. "Please tell her that the baby is dead", we say. We file a report and leave, drive away, faster and faster in the darkness. Far in the distance, beyond the dry hills and isolated roads, Soweto is burning.
I have written a lot about God in this past year, generally to reflect on his absence. The problem of evil haunts me: how could a benevolent God allow the horrors I see all around me? Perhaps worse, how could he blind so much of the world to the suffering that is so obvious it shakes me to the core, keeps me awake at night? There is so much pain, and for what reason? For a long time I have not believed in God. Rabbi Hillel said that most people live their lives in an easy darkness, unaware of their blindness. A few, however, are tormented by lightning: occasional flashes of realization that light up the earth and shake them from complacency. My experience this year has been one long lightning storm; sometimes it is a nightmare that I cannot wake up from, but other times I'm glad, because I am no longer sleeping.
I suppose that it would have been easy for God to make people good, to always make the right choices and create a happy world. But instead of goodness, God gave us an even greater gift: he gave us freedom. Uniquely, we have the ability to analyze and reflect, thereby making genuine choices. Those decisions will not always be right or just, and humanity as a whole has suffered for it. Greed, hatred, bigamy, ignorance... they plague us as a people, and yet most of the time we continue to walk in darkness, blissfully unaware of the evil we have allowed ourselves. But God in his wisdom has in fact given us two gifts: Free will, and Insight. I believe in God because I have seen the lightning; I have felt the truth and am blessed with the ability and opportunity to bring change, however small. It is a challenge that we all must answer, each in our own way. My time in India and Africa has been illuminating... I am coming home with enough thoughts to write without stopping until the end of my days. There is so much to see, to do, to experience and to change that it is nearly overwhelming... I take deep breaths and continue on, small steps and one at a time.
Thank you to everyone I have worked with - all of the amazing people and organizations that have made this year possible. You have enriched my life beyond belief, and I hope that in the years to come I prove worthy of the opportunities you have granted me. I have two more weeks in South Africa, mostly on holiday, but I will continue to write. After all, there is so much more to say. I am sitting here now, listening to the familiar Metallica tune that blasted on the radio a few nights ago in the paramedic response car. The deafening instruments do not drown out the original inspiration, Jon Dunne's 16th century poem in which he famously wrote that "any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee."
Saturday, April 19, 2008
Pesach
This Passover, as we commemorate the Jews' liberation from over two centuries of slavery, let's not forget those who are still enslaved by unthinking foreign policies and bad government. As demands for biofuels increase and food prices rise, the frankly horribly predictable problem of worldwide hunger is growing at a faster rate than ever in the past three decades.
If Not Now, When?
What happens to a dream deferred?
There is a famous poem by Langston Hughes written around the time of the Harlem Renaissance called "A Dream Deferred"... Hughes asks, "what happens to a dream deferred? Does it dry up like a raisin in the sun? Or maybe it just sags like a heavy load... or does it explode?". Soweto, in may ways, is the answer to that question and its aftermath: What happens to a population that has been systematically repressed for so long, their dreams whittled down to aspirations for the basic human rights of recognition and equality? And, even more so, what happens when those dreams finally come true?
I went to Soweto last weekend as part of a small tour group run by Imbeza tours. The woman running the operation, Mandy, was engaging and provocative, immediately honing in on our interests and pushing for dialogue. Almost as soon as I got into the van, she started up a conversation about South Africa's politics and economic situation... she remarked that S. Africa's economy was growing too quickly. Now, this opinion took me by surprise, of course, because according to pretty much any political/ economic journal, S. Africa's economy is growing at a much slower rate than anticipated. Originally, when the ANC came to power, there was a lot of speculation about which way the country would go - would it descend into eventual chaos, like Zimbabwe, or would it putter and struggle along, eventually becoming a free democracy? Although civil war hasn't broken out, the ANC's economic and social policies, while on some level idealistically successful, haven't really panned out when it comes to market growth. Domestic companies are frustrated with the black empowerment laws that force them to hire certain percentages of non-whites for "leadership" positions, without simultaneously ensuring that the black work force is also educated enough for those positions. International companies, generally weary of Africa, seem to still be watching what happens... China is, in fact, quickly moving in to fill that gap, but the economic progress is nonetheless not as, well, progressive as it should be. Nelson Mandela, when touring Europe a few years ago and meeting with world leaders was asked why, amidst all the praises, these leaders aren't doing anything more to help South Africa develop. He replied, "they don't have any ink in their pens". The whole world seems to know that this country isn't doing as well as it should be... so why does Mandy think it's growing too quickly?
Mandy's answer touches on the frustrations that must be felt by many South Africans - when change comes, why doesn't it take them along? She reflects that the international companies establishing themselves in South Africa - opening banks, buying properties - are only benefiting those who are already part of the "white" system: in other words, only those who are educated and part of the current economic infrastructure are getting the jobs and, subsequently, an increase in their standard of living. But what about those who have been systematically excluded? During apartheid, the government made it official policy to provide purposefully poor education to the black communities - schools (shacks, really) would employ one teacher for more than a hundred students, and only the most basic materials were provided. Students would generally only study through primary school, afterwards joining the blue collar work force if they hadn't already dropped out. Only the wealthy few could afford a better education, and as a result illiteracy is widespread throughout even the most urban communities, such as Soweto. Since the ANC came into power the rhetoric has changed, but practical differences are barely noticeable. Public schools in Soweto are only improving slowly, and the funds that are supposed to be allotted to education and socioeconomic development in the poorest areas "disappear". The most frustrated seem to be the middle-class blacks: too "rich" for even meagre government subsidies, but without the resources to afford private education, how do they break into the system? What good is the end of political oppression if socioeconomic status remains the same, without any reasonable hope for change?
According to Mandy, the government should be focusing less on trying to appease foreign companies and recruiting more investors and instead put more efforts into education and housing. "But what about the tax revenues?" I asked... shouldn't the money that comes from investments be helping the poor? How else could the government get funding for the social programs she wants? Mandy paused and agreed with me that that was an interesting point... interesting, but not relevant because things aren't working that way in South Africa. Yes, taxes should be helping the poor - but they're not. They're either mismanaged, misappropriated, or simply disappear. But how could an economic slowdown possibly be the answer? Mandy pauses. "It would equal things out a little", she says after a while.
We drove through different neighborhoods, rich and poor, crossing the boundaries between million dollar houses and shacks in just minutes. We walked around, handed out food, and photographed. I saw the sights and sounds of Soweto that day - smelled chicken roasting on metal cans, tobacco wafting through ramshackle shebeens. But it is the soul of Soweto that I really wanted to see... Mandy gave me a window, but then the curtains closed and the tour was over. I got a glimpse of how the people must feel... it's unfair, things don't seem to change, when is it their turn? It's easy to say that I don't have those answers and, frankly, it's not my responsibility to know... I'm just here to stitch people up, right? As I uploaded photographs to my laptop that night, Rabbi Hillel's famous words resonated in the back of my mind "...If I am not for others, who am I? And if not now, when?".
Stark contrasts in living conditions between the rich and poor areas of Soweto, all black, ask questions that go far beyond the typical "race" dialogues
Young girl waits outside her house as a river of sewage runs past
Women cook chicken on a fire outdoors
Young girl pumps water... the poor neighborhoods of Soweto don't have indoor plumbing
Boy plays with a plastic gun... when do games become reality?
On the way to school
Elderly man relaxes in the late afternoon
Alcohol is a major problem in Soweto...
Thursday, April 17, 2008
Philosophical Diversion
Recently, I shared some of Bertrand Russell's writings with a friend; scanning his essays for the most meaningful, accessible bits made me excited about his work all over again... so much so that I feel compelled to post a small excerpt here. This is the preface to his autobiography, entitled "What I Have Lived For"... it is one of the most beautiful passages I have ever read, and it speaks to me deeply. Russel was a brilliant philosopher (yes, and mathematician...) in many fields, but it is his passion for self-reflection and honesty of vision that I admire most. In my opinion, one of the greatest pitfalls of 'modern' living is the ability to walk through life blind, without contemplation; it's easy to become well-fed shells going through the motions without ever looking deeper into ourselves. Russell not only embodied the antithesis of that, he lived its principles. Now, of course, the passage below, beautiful as it may be, is brief and inevitably superficial. But, it's 11am and I haven't slept in nearly 30 hours, so....
What I Have Lived For
Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind. These passions, like great winds, have blown me hither and thither, in a wayward course, over a great ocean of anguish, reaching to the very verge of despair.
I have sought love, first, because it brings ecstasy - ecstasy so great that I would often have sacrificed all the rest of life for a few hours of this joy. I have sought it, next, because it relieves loneliness--that terrible loneliness in which one shivering consciousness looks over the rim of the world into the cold unfathomable lifeless abyss. I have sought it finally, because in the union of love I have seen, in a mystic miniature, the prefiguring vision of the heaven that saints and poets have imagined. This is what I sought, and though it might seem too good for human life, this is what--at last--I have found.
With equal passion I have sought knowledge. I have wished to understand the hearts of men. I have wished to know why the stars shine. And I have tried to apprehend the Pythagorean power by which number holds sway above the flux. A little of this, but not much, I have achieved.
Love and knowledge, so far as they were possible, led upward toward the heavens. But always pity brought me back to earth. Echoes of cries of pain reverberate in my heart. Children in famine, victims tortured by oppressors, helpless old people a burden to their sons, and the whole world of loneliness, poverty, and pain make a mockery of what human life should be. I long to alleviate this evil, but I cannot, and I too suffer.
This has been my life. I have found it worth living, and would gladly live it again if the chance were offered me.
.
What I Have Lived For
Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind. These passions, like great winds, have blown me hither and thither, in a wayward course, over a great ocean of anguish, reaching to the very verge of despair.
I have sought love, first, because it brings ecstasy - ecstasy so great that I would often have sacrificed all the rest of life for a few hours of this joy. I have sought it, next, because it relieves loneliness--that terrible loneliness in which one shivering consciousness looks over the rim of the world into the cold unfathomable lifeless abyss. I have sought it finally, because in the union of love I have seen, in a mystic miniature, the prefiguring vision of the heaven that saints and poets have imagined. This is what I sought, and though it might seem too good for human life, this is what--at last--I have found.
With equal passion I have sought knowledge. I have wished to understand the hearts of men. I have wished to know why the stars shine. And I have tried to apprehend the Pythagorean power by which number holds sway above the flux. A little of this, but not much, I have achieved.
Love and knowledge, so far as they were possible, led upward toward the heavens. But always pity brought me back to earth. Echoes of cries of pain reverberate in my heart. Children in famine, victims tortured by oppressors, helpless old people a burden to their sons, and the whole world of loneliness, poverty, and pain make a mockery of what human life should be. I long to alleviate this evil, but I cannot, and I too suffer.
This has been my life. I have found it worth living, and would gladly live it again if the chance were offered me.
.
Sunday, April 13, 2008
Personal Statement!
Hey everyone, and thanks for reading... apologies for not updating the blog for the last week, I've been busy working (ok, just a little!), abseiling, caving, hiking, and... working on a personal statement! I need to submit a mini essay on "why I want to be an emergency medicine physician" to USC/Keck School of Medicine in order to do a rotation there... this morning I woke up with a little inspiration and finally wrote something! I pasted the statement below... please post or email comments, as I would *love* all and any feedback! I'm submitting the essay sometime Tuesday afternoon, so please send comments by then! Thanks a lot, and I promise more updates this week!
*****
Thank you for the input to everyone who emailed/ posted comments... more updates to come soon!
*****
Thank you for the input to everyone who emailed/ posted comments... more updates to come soon!
Sunday, April 6, 2008
Sharing an Article...
I just came across this while browsing the NY Times online... as Rutgers is my alma mater, and since I graduated with a BA in Philosophy less than four years ago, I just had to post this...
http://www.nytimes.com/2008/04/06/education/06philosophy.html?
em&ex=1207627200&en=cf25c58a650590d5&ei=5087%0A
Go Rutgers, And props to the Philosophy Department. I'm thrilled that more and more students are realizing the benefits of taking a few minutes (hours? years?) out to examine life from a deeper perspective... majoring in philosophy was probably one of the best decisions I made in college.
http://www.nytimes.com/2008/04/06/education/06philosophy.html?
em&ex=1207627200&en=cf25c58a650590d5&ei=5087%0A
Go Rutgers, And props to the Philosophy Department. I'm thrilled that more and more students are realizing the benefits of taking a few minutes (hours? years?) out to examine life from a deeper perspective... majoring in philosophy was probably one of the best decisions I made in college.
Fun at Work?
I was dressed up as a drunk, combative car accident victim for the final exam of the ATLS course... and had a great time!
Yeah, we have a lot of fun... or, I suppose, at least I do... lodged between the long hours, the chaos, the depressing stories and the violence, there's a lighter side to things (honestly, there is!). The trick to getting through the day - in fact, the secret to loving the days - is to find humor in every situation. Some days, things seem so ridiculous that I pretend I'm actually on "Candid Camera" and am being taped for a reality TV show... often, it's the only explanation that makes any sense. I remember walking through the trauma unit one morning, coffee cup in hand... there's a guy sleeping (and snoring very loudly) in a pool of blood (his own, I hope...) on the floor... a paramedic is holding a patient's amputated foot in a plastic bag near the door. There is a woman who was bitten by her boyfriend, a man who jumped off a train, and three police officers guarding a man who is so drunk that he's asleep, half on a chair/ half on the floor, butt straight up in the air. I mean... it must be some kind of dark comedy script, right? It's weird, it's funny, it's surreal... except that, of course, it's actually real, and so then you stop chuckling and get to work.
Saturday was my last shift at the Joberg Gen. In five weeks, I've done 23 12-14 hour shifts, plus a three-day ATLS course. In that time, I've placed 8 chest tubes, 3 central lines, and assisted with two DPLs. I don't even know how much I've sutured, or how many ABGs or IV's I have placed... I lost count a long time ago. I'm exhausted. In some ways, it's hard to believe that it has only been five weeks... I have become to comfortable here, in Joberg and the hospital; I've met so many people, made friends, traveled about... it almost feels like I live here. The shifts have sometimes flown by in a flurry of activity, and other times, when the patient flow slows to a manageable trickle, long conversations about politics or philosophy break out over weak coffee and cold Nando's chicken. I have loved all of it, every last bit; I say that honestly, acknowledging that each and every terrible thing, all of the inefficiencies, the preventable morbidities, the horror of the constant violence and underlying racial tensions - everything that I have experienced here has been more than worth it. Life here is exactly what I often feel is lacking back home: it is real, so very, very real, that it's impossible to deny or avoid. In the states, particularly in the more affluent communities, it feels that life is lived in a bubble of cars, fashion, and shopping malls... here, in the hallways of 163, the frivolous concerns of suburbia couldn't be further away. I don't find myself constantly rolling my eyes... i'm too busy caring for patients, too busy learning and feeling what is real as it ebbs all around me. I suppose this is part of the reason why I chose to become a doctor, why I'm going to specialize in emergency medicine, and why I insist on practicing it in the busiest, most chaotic conditions available. Maybe this desire will pass as I get older, more tired and jaded... but for now I'm more than happy to roll up my sleeves and get my hands dirty... thank you, Africa, for giving me this opportunity. I'll be back!
After relaxing on Sunday, I will start two weeks of trauma ICU at Chris Hani Baragwanath ('Bara') Hospital on Monday. Bara is the major "university" hospital serving Soweto, a poor, historic township just minutes from Johannesburg. It is home to an estimated 4-5 million people, mainly poor black families, and is one of the most violent areas in all of Joberg. Bara hospital is one of the largest hospitals in the world, with 3,500 beds, and runs one of the busiest trauma services in all of Africa. But, more on that in the next post... for now, I want to take you on a brief , illustrated tour of the Joberg Gen. Enjoy!
Welcome to the Trauma Unit! Enter at your own risk... :)
The entrance to 163 is a locked metal gate... enough said!!
Hanging out with Nick and Marius at the end of a 14 hour shift. It's 7am and we're exhausted... why are we smiling?!
Looking at an x-ray with Colin... I honestly don't think he's capable of looking serious in *any* photograph!
Mariana, me, and Colin in one of the trauma bays.
Kids, don't try this at home!! Especially because i'm doing it wrong (there's no mask on the end of that BVM!) But it's all for the photo anyway... :P
Linh (an elective student from Germany) says that "all Asians love doing this in photos!"...
... I thought i'd give it a try too :)
Hey everyone! Thanks for reading, and stay tuned for more updates and photos! Just as soon as I get a little more sleep...
Friday, April 4, 2008
Wild Things... You Make My Heart Sing!
So, it's been a while since I posted photographs... here they are! More to come soon... This post is of the animal-friendly variety (though not necessarily of friendly animals... read on!)
Making friends in Zanzibar... I met this little guy at the night market, and babysat him while his "owner" stepped away to "do some business" for a few hours... but we had fun! Tiny monkeys love sugarcane juice, in case you were wondering...
Trying on a 50kg snake at the Gold Reef, Johannesburg. Don't worry mom, he was friendly!
So, Colin and I decided to go on a do-it-yourself safari at a local animal reserve... this is our "safari vehicle", a late 80's LaserTracer! Shockingly, he survived the ride... what happened? See below...
We drove into the "Predators" section of the park, apparently disturbing a lion and his women... the lion was not pleased... this is him sizing up our, um, not-so-rugged car...
This is the lion preparing to pounce... Colin has his camera running, and there's a video clip of me screaming for him to get moving!! The lions basically chased us out, but I was clicking photos the entire time!!
The lion is way, way too close to our car!! This is *without* zooming!
Awww, tired... an older lion yawns and basically ignores us. Phew!
Hey there beautiful... look at those eyes!!
Making friends in Zanzibar... I met this little guy at the night market, and babysat him while his "owner" stepped away to "do some business" for a few hours... but we had fun! Tiny monkeys love sugarcane juice, in case you were wondering...
Trying on a 50kg snake at the Gold Reef, Johannesburg. Don't worry mom, he was friendly!
So, Colin and I decided to go on a do-it-yourself safari at a local animal reserve... this is our "safari vehicle", a late 80's LaserTracer! Shockingly, he survived the ride... what happened? See below...
We drove into the "Predators" section of the park, apparently disturbing a lion and his women... the lion was not pleased... this is him sizing up our, um, not-so-rugged car...
This is the lion preparing to pounce... Colin has his camera running, and there's a video clip of me screaming for him to get moving!! The lions basically chased us out, but I was clicking photos the entire time!!
The lion is way, way too close to our car!! This is *without* zooming!
Awww, tired... an older lion yawns and basically ignores us. Phew!
Hey there beautiful... look at those eyes!!
Saturday, March 29, 2008
Freedom
Last Friday night I decided it was time to let my hair down; there was a huge concert playing in Johannesburg, aptly named the "Coke Fest" (I'm endlessly amused by double meanings...) and what better way to spend a warm evening than watching Korn and Muse play live in the company of 46,000 goth-influenced, strung-out-on-coke-and-what-have-you high schoolers? But, really, it was a blast. Apparently, plastic cups of warm beer and eardrum-piercing rock was exactly what I needed to smooth over the tensions of the past few weeks and remind myself that, after all, I don't always have to be the "doctor" - sometimes I can let go and just melt into the sea of punk rockers moshing away into the night. I went with Craig, a South African I met through friends; we both searched for Paris Hilton (though, really, with only the vaguest desire to actually find her), but settled for just seeing her boyfriend. Good Chariot is *fantastic*. At some point during the concert, I was momentarily startled by a young man (god, am I old?) with dark brown hair gelled into six foot-long spikes projecting straight up from his head. It could have been NJ.
As the days in 163 (the trauma unit) go by, I find myself settling into routine more and more, approaching the resuscitations with greater ease and peace of mind, taking on more difficult procedures and increasingly being able to work independently. In just three and a half weeks, I have placed seven chest tubes, countless drips and ABGs, set fingers and shoulders back into place (well...usually), and sutured everything from skin to - yes!! - a tendon. Of course, everything I'm doing is just a sampling of things to come, but spending long nights in the trauma unit has reminded me just how much I love this kind of work; despite the difficulties, I know that I am exactly where I've always wanted to be. Over the past three days I've been auditing an ATLS course at the Wits Medical School; it's an advanced trauma life support course for physicians, but medical students and nurses can participate fully (I'll just have to wait till next year to get my actual certification). The class was great, but most importantly, early this morning, something dawned on me. Yesterday was our "procedures lab"; we watched a brief video and then spent three cold hours in the animal lab practicing cricothyroidotomies, DPLs, thoracostomies, and venous cutdowns on euthanized pigs. Sometime in the middle of my second pericardiocentesis (you stick a needle into the membrane around the heart to evacuate blood), a thought suddenly struck me: just nine years ago, I first became an EMT, first became enamoured with the idea of jumping out of an ambulance, lights flashing and horns blaring. Just a short while ago I was a nervous teenager fiddling with suction catheters and oxygen masks, trying to look confident as I repeated the ABC's over and over in my mind. Now here I am, in Africa, practicing surgical airways! And, more importantly, this is just the beginning. I was proud for that moment, standing there, thinking, I set out to accomplish something - not anything extraordinary, but nothing guaranteed, either; and, I'm doing it. For a moment I felt the power of having direction, of having the will to chase dreams... is it really possible that my wildest fantasies could come true? Do I really have what it takes to make it happen? It was a great moment... and then the moment passed and I was left standing with a goofy look on my face, needle still in hand. People talk about doors closing as you get older... for me, I feel long hallways all around me; they're dark and sometimes lonely, but I can follow them anywhere. I can feel it.
Just a few years ago, I remember on one particularly dark evening telling my best friend Josh that I felt as though I was walking on a thin wire, surrounded by so much life but unable to reach out and touch any of it. I felt as though I was suffocating; I hated medical school, hated the mindless minutia drilled into us, hated the endless labs and lectures and obnoxious classmates who had studied biochemistry since they were two. I look back at those days and shudder; there was nothing overly dramatic about my words; I really did feel trapped. I realize now that my frustration wasn't so much with the curriculum, but with myself. I felt that I was following a path I didn't really want to be on, with no foreseeable way out. At that point, everything I had done in my life was more or less prescribed - high school, college, and now medical school. True, I had gone that way because of my own choices; no one forced me to become a doctor. I did however feel that I needed time - time to reassess, to see more of the world, to learn about myself; I felt rushed through life, as though I was running towards some goal in the distance that wouldn't wait for me... if I slowed down and took a breath, would everything fall apart? This year was about taking that time, learning and seeing what I felt I had been missing... would I come to regret my time "out"? Would I return disenchanted, bored, sick? My parents thought this was a terrible decision; my friends, for the most part, either thought it was dangerous or just didn't understand the point. But I went ahead anyway, because I knew I had to; over the years, I had allowed my soul to slip away from me, I had lost my muse and no longer remembered why I was doing anything. I took a stand and left... and now, standing in the trauma bay in one of Africa's busiest hospitals, ready to do the things I have only dreamed of... now I feel alive, now I feel accomplished, now I have remembered who I am and what I want. After all this time and hard work, I have finally regained the serenity I lost a long time ago. My dreams and ambitions don't make my life any easier, but at least I know that I have something to look forward to.
Just for fun, as long as I'm going on and on about dreams, I'm going to import my list of "greatest dreams" from Facebook... I'm posting it below. Dreams, of course, are fluid, and I'm sure that this list will change over time; also, it is by no means all-encompassing or in any particular order. But, it's on my mind, and since the point of this blog is to share whatever randomness my neurons come up with, here it is.
Greatest Dreams/ Ambitions:
- Spend a year driving across Africa, stopping to do medical work and photography and following the trail of Dr. David Livingstone. Maybe write a book along the way? Or at least take lots of pictures.
- Become a photojournalist for the New York Times... alternatively, freelance for Reuters.
- Move to Israel, live on a kibbutz in the Galilee, and work for an activist NGO promoting human rights and providing free medical care to immigrants, refugees, and Bedouins.
- Spend a year living in the Australian outback, working as a flight/ emergency doc in the bush
- Come back to South Africa and work as a flight doctor/ ATLS/ paramedic instructor for Netcare 911, the largest air rescue service out of Johannesburg
- Adopt a dog
- Become fluent in Spanish and Hebrew
- Put together a photography exhibit on the melting of cultures and religions in Jerusalem, my favorite city in the world (hmm... maybe this is something for next year?)
- Learn to drive stick shift... on a Land Rover... in Africa? Well, ok, at least learn to drive stick, damn it.
- Let myself fall in love again, even if it hurts... at some point I have to be willing to open up my heart again, right? Still waiting on that one...
Ok, that's it for now... more updates and, yes, photographs! to come soon. For now, it's raining, and it's Saturday, and that means I should be putting on gloves and a gown upstairs in the trauma ward. I'm ready.
As the days in 163 (the trauma unit) go by, I find myself settling into routine more and more, approaching the resuscitations with greater ease and peace of mind, taking on more difficult procedures and increasingly being able to work independently. In just three and a half weeks, I have placed seven chest tubes, countless drips and ABGs, set fingers and shoulders back into place (well...usually), and sutured everything from skin to - yes!! - a tendon. Of course, everything I'm doing is just a sampling of things to come, but spending long nights in the trauma unit has reminded me just how much I love this kind of work; despite the difficulties, I know that I am exactly where I've always wanted to be. Over the past three days I've been auditing an ATLS course at the Wits Medical School; it's an advanced trauma life support course for physicians, but medical students and nurses can participate fully (I'll just have to wait till next year to get my actual certification). The class was great, but most importantly, early this morning, something dawned on me. Yesterday was our "procedures lab"; we watched a brief video and then spent three cold hours in the animal lab practicing cricothyroidotomies, DPLs, thoracostomies, and venous cutdowns on euthanized pigs. Sometime in the middle of my second pericardiocentesis (you stick a needle into the membrane around the heart to evacuate blood), a thought suddenly struck me: just nine years ago, I first became an EMT, first became enamoured with the idea of jumping out of an ambulance, lights flashing and horns blaring. Just a short while ago I was a nervous teenager fiddling with suction catheters and oxygen masks, trying to look confident as I repeated the ABC's over and over in my mind. Now here I am, in Africa, practicing surgical airways! And, more importantly, this is just the beginning. I was proud for that moment, standing there, thinking, I set out to accomplish something - not anything extraordinary, but nothing guaranteed, either; and, I'm doing it. For a moment I felt the power of having direction, of having the will to chase dreams... is it really possible that my wildest fantasies could come true? Do I really have what it takes to make it happen? It was a great moment... and then the moment passed and I was left standing with a goofy look on my face, needle still in hand. People talk about doors closing as you get older... for me, I feel long hallways all around me; they're dark and sometimes lonely, but I can follow them anywhere. I can feel it.
Just a few years ago, I remember on one particularly dark evening telling my best friend Josh that I felt as though I was walking on a thin wire, surrounded by so much life but unable to reach out and touch any of it. I felt as though I was suffocating; I hated medical school, hated the mindless minutia drilled into us, hated the endless labs and lectures and obnoxious classmates who had studied biochemistry since they were two. I look back at those days and shudder; there was nothing overly dramatic about my words; I really did feel trapped. I realize now that my frustration wasn't so much with the curriculum, but with myself. I felt that I was following a path I didn't really want to be on, with no foreseeable way out. At that point, everything I had done in my life was more or less prescribed - high school, college, and now medical school. True, I had gone that way because of my own choices; no one forced me to become a doctor. I did however feel that I needed time - time to reassess, to see more of the world, to learn about myself; I felt rushed through life, as though I was running towards some goal in the distance that wouldn't wait for me... if I slowed down and took a breath, would everything fall apart? This year was about taking that time, learning and seeing what I felt I had been missing... would I come to regret my time "out"? Would I return disenchanted, bored, sick? My parents thought this was a terrible decision; my friends, for the most part, either thought it was dangerous or just didn't understand the point. But I went ahead anyway, because I knew I had to; over the years, I had allowed my soul to slip away from me, I had lost my muse and no longer remembered why I was doing anything. I took a stand and left... and now, standing in the trauma bay in one of Africa's busiest hospitals, ready to do the things I have only dreamed of... now I feel alive, now I feel accomplished, now I have remembered who I am and what I want. After all this time and hard work, I have finally regained the serenity I lost a long time ago. My dreams and ambitions don't make my life any easier, but at least I know that I have something to look forward to.
Just for fun, as long as I'm going on and on about dreams, I'm going to import my list of "greatest dreams" from Facebook... I'm posting it below. Dreams, of course, are fluid, and I'm sure that this list will change over time; also, it is by no means all-encompassing or in any particular order. But, it's on my mind, and since the point of this blog is to share whatever randomness my neurons come up with, here it is.
Greatest Dreams/ Ambitions:
- Spend a year driving across Africa, stopping to do medical work and photography and following the trail of Dr. David Livingstone. Maybe write a book along the way? Or at least take lots of pictures.
- Become a photojournalist for the New York Times... alternatively, freelance for Reuters.
- Move to Israel, live on a kibbutz in the Galilee, and work for an activist NGO promoting human rights and providing free medical care to immigrants, refugees, and Bedouins.
- Spend a year living in the Australian outback, working as a flight/ emergency doc in the bush
- Come back to South Africa and work as a flight doctor/ ATLS/ paramedic instructor for Netcare 911, the largest air rescue service out of Johannesburg
- Adopt a dog
- Become fluent in Spanish and Hebrew
- Put together a photography exhibit on the melting of cultures and religions in Jerusalem, my favorite city in the world (hmm... maybe this is something for next year?)
- Learn to drive stick shift... on a Land Rover... in Africa? Well, ok, at least learn to drive stick, damn it.
- Let myself fall in love again, even if it hurts... at some point I have to be willing to open up my heart again, right? Still waiting on that one...
Ok, that's it for now... more updates and, yes, photographs! to come soon. For now, it's raining, and it's Saturday, and that means I should be putting on gloves and a gown upstairs in the trauma ward. I'm ready.
Saturday, March 22, 2008
You just can't make this stuff up.
I decided to take note of the particularly absurd occurrences in the Joberg trauma department... this is just from Friday night:
Psychologist: Hey, we're looking for a medical student to watch the psych patient while he has a cigarette outside
Me: You mean the violent one who tried to kill himself?
Psychologist: Yeah, him... we just need someone to watch him and make sure he doesn't do anything, because he still has his knife
Me: What?! Why don't you just take it away?
Psychologist: We're afraid he might be violent... anyway, is there a medical student around?
Me: No.
----------------------------------
Woman: Doctor, doctor, I have a baby
Me: Alright.... is something wrong with the baby?
Woman: Yes, i've had him for one month
Me: And.... is there a problem?
Woman: Yes, he's dead now.
Me: Uh, dead? Now? Since when?
Woman: Since yesterday, he has died. Do you want to see him?
Me: Uh... dead babies, right. That's pediatrics. I'll walk you over.
---------------------------------
Claire (resident): I went to get coffee out of the pantry, but someone stole it.
Me: Someone stole the coffee?
Claire: No, the pantry.
--------------------------------
Me (to a very intoxicated, bloody woman): Hi, ma'am, what happened to you?
Woman: I don't know
Me: What do you mean, you don't know? You have stab wounds all over you!
Woman: Then I guess I got stabbed
-------------------------------
True story: A woman came in, a transfer from a private hospital, with an external fixation (large screws) bolted to her tibia (long bone in the leg). It was nicely done, and there would have been no problem, except that it was actually her ankle that was broken. She was being transferred for "further management".
------------------------------
In the trauma bays, we no longer have ANY functioning manual blood pressure cuffs or working batteries in the portable monitors. I went upstairs to ask Vascular to borrow one of their monitors so that we could take our patient to the CT scanner, and they just laughed at me. I guess it's funny if it's not your patient...?
Sigh. This is Africa.
Psychologist: Hey, we're looking for a medical student to watch the psych patient while he has a cigarette outside
Me: You mean the violent one who tried to kill himself?
Psychologist: Yeah, him... we just need someone to watch him and make sure he doesn't do anything, because he still has his knife
Me: What?! Why don't you just take it away?
Psychologist: We're afraid he might be violent... anyway, is there a medical student around?
Me: No.
----------------------------------
Woman: Doctor, doctor, I have a baby
Me: Alright.... is something wrong with the baby?
Woman: Yes, i've had him for one month
Me: And.... is there a problem?
Woman: Yes, he's dead now.
Me: Uh, dead? Now? Since when?
Woman: Since yesterday, he has died. Do you want to see him?
Me: Uh... dead babies, right. That's pediatrics. I'll walk you over.
---------------------------------
Claire (resident): I went to get coffee out of the pantry, but someone stole it.
Me: Someone stole the coffee?
Claire: No, the pantry.
--------------------------------
Me (to a very intoxicated, bloody woman): Hi, ma'am, what happened to you?
Woman: I don't know
Me: What do you mean, you don't know? You have stab wounds all over you!
Woman: Then I guess I got stabbed
-------------------------------
True story: A woman came in, a transfer from a private hospital, with an external fixation (large screws) bolted to her tibia (long bone in the leg). It was nicely done, and there would have been no problem, except that it was actually her ankle that was broken. She was being transferred for "further management".
------------------------------
In the trauma bays, we no longer have ANY functioning manual blood pressure cuffs or working batteries in the portable monitors. I went upstairs to ask Vascular to borrow one of their monitors so that we could take our patient to the CT scanner, and they just laughed at me. I guess it's funny if it's not your patient...?
Sigh. This is Africa.
Sunday, March 16, 2008
Bed Days
A pounding headache shook me awake from the deepest of nightmares... I only remember gunshots, and then a steady pounding at the back of my skull, drowning out any further thoughts of sleep. I sat awake for hours, trying to breathing deeply, willing myself into a meditative trance... willing the pain to stop, praying to sleep, to pass out, anything... but there was only the pounding, waves of nausea, and a steady, pouring rain storm that shook my window and made the wind chimes scream. By six AM I found my migraine medicine, a dark green bottle I had left in Colin's room the night before; I swallowed more pills that I should have and crawled back into bed with strong tea and dark rye bread, vowing to hide under the covers for the rest of the day. That was lucky, because Colin's car died in the middle of traffic on his way to the hospital, forcing him to wait amidst angry, honking drivers and bone-chilling wind for AAA to jar it back to life. I woke up mid-afternoon to shower and register for next year's clerkships... the bathroom was flooded and the server was down. My scrubs are still soaked, waving pitifully on the clothesline after four days of rain; a long-awaited friend hasn't called and I have allowed my mood to darken inconsolably. There are days when we should all just stay in bed... though I do plan on getting up tomorrow.
Friday, March 14, 2008
Rain Dreams
There is a tense, distinctly palpable feeling of dread in South Africa, emulating the calm before a storm... serene, but teetering on the edge of chaos; you don't have to go out of your way for the experience. For the past week, the residence hall where I've been staying has had no electricity, and the (cold) water only came back on Tuesday. The toilets wouldn't flush, trash piled up, and, most disturbingly, security gates didn't lock. One of the orthopedics registrars (residents) offered to let me shower in their on-call room, but the idea of lathering up in the hospital wasn't the most appealing... I joked about setting up a basin in one of the trauma bays just before morning sign-out... "excuse me, guys, could you please get my back?". Well... it was funny, maybe you had to be there, but after three days of, essentially, camping, I decided it was time to move out. Colin's landlady, Michelle, offered me a room in her house and, after some confusion (and a very upset black Labrador retriever), I packed up my things and, with Colin's help, moved over. Michelle is South African and her husband is Greek, a fact that's confirmed by the myriad of aromas steaming (yes, literally) out from the kitchen. The house is beautiful... small, decorated in an eclectic Afro-European style, and complete with a sweet, hyper sausage dog and a very fluffy, horribly allergenic cat. My room looks out into the garden with a small, oval swimming pool tucked between an exotic collection of trees and plants... I'm in heaven. I have already been spending a lot of time at the house, hanging out with Colin on evenings off, so being able to stay here overnight is just an added bonus.
Work is more of the same... so much more that I'm shocked at my lingering empathy. Some stories look like they could have been plucked from season premiers of Grey's Anatomy, except that the drama seems secondary when you're dealing with real human beings laying out in front of you. A 35-year-old woman, Thembe, came in yesterday, hit by a car speeding along a side road... she had just turned 35, it was actually her birthday. Although she was "stable", her c-spine x-rays showed suspicious shadows and markings... a reconstruction CT demonstrated a c4-c5 avulsion that severed her spinal cord... in other words, in all likelihood, she'll never walk again. I assisted the orthopedic surgeon as he screwed calipers into her skull, attaching 7 kg of weight for spinal traction. She moaned quietly and asked me repeatedly to reposition her legs. I would have, except that they were already lying flat... she just didn't yet realize that she simply couldn't feel anything. I swallowed hard, and for once was greateful that I don't speak Zulu, that I had a convenient excuse to not explain the details. Her family came and left, obviously upset but not hysterical. This is Africa, this is what happens in Africa. It happens everywhere, really, but here it is so commonplace that the senselessness seems to be more the rule than an exception to it. I gave her 3 of morphine and her vital signs dropped... 115/70, 103/65, 92/55. I was nervous, watching the monitor, but held back on giving epinephrine.... after all, with her spine paralyzed, she had a diminished sympathetic tone... in other words, even her body was struggling to understand what was going on, struggling - and failing - to maintain her vascular tone. She was eventually moved upstairs to the ICU, and I pasted her ID sticker into my notebook, vowing to check up on her in a few days. Thembe's scenario disturbs me, as she is living out my worst nightmare.... just an innocent bystander, just walking, for god's sake, and now paralyzed. I think that I would rather be dead than paralyzed.
I pushed more morphine into her veins before they took her up, wishing her a drugged, dizzy sleep where she would dream of anything else. Then I went home, to my new, comfortable bed, and fell asleep nestled in a thick sea-green comforter. I dreamt of merciless rainstorms, pounding down on the earth, flooding it, drowning everything. I woke up, shaking but still dry; outside the ground was soaked, naked branches swinging in the passing wind. I shut my eyes for a few more minutes, willing Africa out of my nightmares.
Work is more of the same... so much more that I'm shocked at my lingering empathy. Some stories look like they could have been plucked from season premiers of Grey's Anatomy, except that the drama seems secondary when you're dealing with real human beings laying out in front of you. A 35-year-old woman, Thembe, came in yesterday, hit by a car speeding along a side road... she had just turned 35, it was actually her birthday. Although she was "stable", her c-spine x-rays showed suspicious shadows and markings... a reconstruction CT demonstrated a c4-c5 avulsion that severed her spinal cord... in other words, in all likelihood, she'll never walk again. I assisted the orthopedic surgeon as he screwed calipers into her skull, attaching 7 kg of weight for spinal traction. She moaned quietly and asked me repeatedly to reposition her legs. I would have, except that they were already lying flat... she just didn't yet realize that she simply couldn't feel anything. I swallowed hard, and for once was greateful that I don't speak Zulu, that I had a convenient excuse to not explain the details. Her family came and left, obviously upset but not hysterical. This is Africa, this is what happens in Africa. It happens everywhere, really, but here it is so commonplace that the senselessness seems to be more the rule than an exception to it. I gave her 3 of morphine and her vital signs dropped... 115/70, 103/65, 92/55. I was nervous, watching the monitor, but held back on giving epinephrine.... after all, with her spine paralyzed, she had a diminished sympathetic tone... in other words, even her body was struggling to understand what was going on, struggling - and failing - to maintain her vascular tone. She was eventually moved upstairs to the ICU, and I pasted her ID sticker into my notebook, vowing to check up on her in a few days. Thembe's scenario disturbs me, as she is living out my worst nightmare.... just an innocent bystander, just walking, for god's sake, and now paralyzed. I think that I would rather be dead than paralyzed.
I pushed more morphine into her veins before they took her up, wishing her a drugged, dizzy sleep where she would dream of anything else. Then I went home, to my new, comfortable bed, and fell asleep nestled in a thick sea-green comforter. I dreamt of merciless rainstorms, pounding down on the earth, flooding it, drowning everything. I woke up, shaking but still dry; outside the ground was soaked, naked branches swinging in the passing wind. I shut my eyes for a few more minutes, willing Africa out of my nightmares.
Wednesday, March 12, 2008
Light Heart, Dark Tea
Dark, blue, sterile. You gingerly unwrap the tightly sealed package and the thin sheets come apart slowly, neat and elegantly balanced on a wheeled metal tray. You touch only the outsides as you pull on gloves; Snap, snap! Powder and latex cover your hands, too long at the fingertips, but you push them down, then ignore them. You glance up; the patient breathes rapidly, looks away; periodic cries from the monitor remind you that it's probably not working again, but you look anyway, hesitate. Back to the patient; jugular notch, three fingers down, nipple line. 4th intercostal space, just anterior to the midaxillary line... is that it? You palpate the ribs, push hard, run fingers along their smooth, dense bodies, rigid underneath the leathery skin. Is this right? Is it here? You pierce the skin with a thin needle, anesthetic seeping under the skin, fuffing it up like an enormous goose-bump. The skin swells, the patient moans, you pull back. Small scalpel blade, the length of a thumb, thin and razor-sharp. You hold it like a butter knife, loose gloved fingers pressing tightly against metal. Right here? You breathe, you cut. Pale, pink tissue gives way under darkest brown... you run the blade along slowly, smoothly, then press harder. Once centimeter... two... four. Crimson drops obscure the view, but that's it, the blade is nearly through. "Forceps!" You're handed a needle driver. There are no forceps. You breathe again and push the blunt metal hard against the incision, pushing through, pushing further through. The patient moans... more anesthesia? No, he's supposed to scream. You push again, then remove the driver and feel with a gloved finger... there is only muscle, so much of it, so thick, hard, nearly inpenetrabale. You push again, harder this time, putting your entire body weight into a trembling hand. You feel as though you're going to fall into his chest, fall into the tiny cavity made larger by the brutal dissection, and still, you're not through, there's more muscle. Deep breath, push again. And then, ah!! You're in, your wrist collapses against his chest as the blunt dissector finally punches through; there is blood, dark, deep, running over you, over the bed, onto the already darkened floor. Quickly, reach a finger in... clots, strings, ribs... you feel hard pulsations reverberating through the lung, barely palpable at your fingertip... it is partially collapsed, and there's blood, so much blood. You pull back, and a thick plastic tube replaces the digit; you release the clamp and blood is allowed to run through, bubbling at the base of the collector. Crouching down, mesmorized by the swinging indicator, you watch the water seal closely. You're in, you're through. Several sutures in, and you're on to the next patient... another chest tube, another ABG, another line. They come through like soldiers in an inexplicable war without a front line, leaving their scent, parts of themselves. Blood, sweat, saline, everything everywhere. You come home to wash but it's still there as you try to sleep... there are dreams of blood, dreams of dark raptures circling overhead. We are like scanvegers, competing for procedures over prematurely slaughtered flesh. We joke, drink coffee, retreat but always come back to chaos. This is emergency medicine, this is trauma. This is real... it is the most real thing I have ever done.
The days are long because they are quieter; the nights run by in a flash of needles and scalpels, splints, drips, and stretchers. I am working nearly every day... tonight will be my ninth shift in less than two weeks and the weekend is yet to come. Sometimes it really is like a war zone and you wonder how people find the money for drugs, weapons... there is so much of it, there seems to be almost nothing else. There are the patients that make you laugh... there was a car accident victim on Saturday night who had suffered a TIA whle driving; we couldn't clear his C-spine right away and so he had to lay on a stretcher for hours, large orange headblocks tightly strapped to his chin and forehead. In a delerium, he would continuously sit up, entirely compromising the immobilization, looking around with a bizzare resemblance to an enormous teletubby. It wasn't funny, but yet it was hysterical... in the middle of the night, i wished for my camera as much as I wished for a faster radiology service. There was a man with a "broken penis" who I was lucky enough to suture... he was stoned out of his mind, and all the better. I think of the patient whose chest x-ray showed possible bowel in his chest, cringe at the battle over whether he would be allowed a CAT scan... back home we CT everyone; here, it is a rare luxury. I have begun to hoard supplies... a small vial of antiseptic cream is tucked into my pocket, several ABG tubes stuffed into another... there is always a shortage of something, monitors breaking, gloves for tourniquets and dirty plastic instead of biohazard bags. It has become a joke - lazy nurses, incompetent technicians, medical students who disappear and cabinets that are never stocked. I ask the residents how they deal and they reply with weary smiles that they know no other way... but then, I do, and that stays with me. Unstable patient? Directly to the OR? No, there is only one OR, and it's booked straight through... just how unstable is he? A young woman was hit by a bus, run over as she was crossing behind it; The stringy, pulpy muscles of her left leg reminded me of cadaver lab as I held it for bandaging, and my stomach turned. Six hours and the vessels are gone, all muscle compartments turned grey, necrotic... when you wake up, you will not have a leg, and your life will be forever changed... i'm sorry, there was only one OR, they know no other way. I do.
They say that there are no atheists in foxholes, but either I am yet to be fully entrenched or "they" are wrong. I don't see god in this work, and I don't see god in the situations that makes it so plentiful. I see predjudice, bitterness, stigma and greed spilling over. I spoke to a patient as I was suturing him, a 37 year old man pushed off a train. Yes, it happens all the time. He has a daughter and works six days a week to make forty dollars. I hesitantly approach two refugees from the Congo, and they eagerly tell me about their dead fathers, about being illegals. I say that I hope we can help, I hope they will be healed, will get asylum. They say it is in God's hands and smile patiently, wearily, but still smile. I look around but I don't see God in these hallways. A petite, white 75 year old woman was turned away by the nurses because she needed a referral first... a referral from an inner city clinic where she could not go because she is old, and she is white. Racism? Realism. I would treat her, and I would treat a little old black lady just the same. But the nurses scowl, speak Zulu, and we turn away... white doctors, asian doctors, not black and not them. Us and Them. Is there racism in my country, a resident asks me. I'm not sure what to say... I shrug and reply there is injustice everywhere. So many patients, so much suffering, and hope? There is hope. I'm looking for it. Elizabeth is still barely responsive, moaning gently to pain but otherwise restless on her startched ICU sheets. I wonder what her morphine dreams look like. I continue to check on her, keep watching the respirator, keep waiting for God to decide.
I am working tonight. I drink dark Rooibos tea and try to lighten my mood, lighen my heart. Perhaps we can make a difference, even if it's just bandaids. If God is indeed here, then I hope he will lend a hand instead of only watching from the sidelines.
The days are long because they are quieter; the nights run by in a flash of needles and scalpels, splints, drips, and stretchers. I am working nearly every day... tonight will be my ninth shift in less than two weeks and the weekend is yet to come. Sometimes it really is like a war zone and you wonder how people find the money for drugs, weapons... there is so much of it, there seems to be almost nothing else. There are the patients that make you laugh... there was a car accident victim on Saturday night who had suffered a TIA whle driving; we couldn't clear his C-spine right away and so he had to lay on a stretcher for hours, large orange headblocks tightly strapped to his chin and forehead. In a delerium, he would continuously sit up, entirely compromising the immobilization, looking around with a bizzare resemblance to an enormous teletubby. It wasn't funny, but yet it was hysterical... in the middle of the night, i wished for my camera as much as I wished for a faster radiology service. There was a man with a "broken penis" who I was lucky enough to suture... he was stoned out of his mind, and all the better. I think of the patient whose chest x-ray showed possible bowel in his chest, cringe at the battle over whether he would be allowed a CAT scan... back home we CT everyone; here, it is a rare luxury. I have begun to hoard supplies... a small vial of antiseptic cream is tucked into my pocket, several ABG tubes stuffed into another... there is always a shortage of something, monitors breaking, gloves for tourniquets and dirty plastic instead of biohazard bags. It has become a joke - lazy nurses, incompetent technicians, medical students who disappear and cabinets that are never stocked. I ask the residents how they deal and they reply with weary smiles that they know no other way... but then, I do, and that stays with me. Unstable patient? Directly to the OR? No, there is only one OR, and it's booked straight through... just how unstable is he? A young woman was hit by a bus, run over as she was crossing behind it; The stringy, pulpy muscles of her left leg reminded me of cadaver lab as I held it for bandaging, and my stomach turned. Six hours and the vessels are gone, all muscle compartments turned grey, necrotic... when you wake up, you will not have a leg, and your life will be forever changed... i'm sorry, there was only one OR, they know no other way. I do.
They say that there are no atheists in foxholes, but either I am yet to be fully entrenched or "they" are wrong. I don't see god in this work, and I don't see god in the situations that makes it so plentiful. I see predjudice, bitterness, stigma and greed spilling over. I spoke to a patient as I was suturing him, a 37 year old man pushed off a train. Yes, it happens all the time. He has a daughter and works six days a week to make forty dollars. I hesitantly approach two refugees from the Congo, and they eagerly tell me about their dead fathers, about being illegals. I say that I hope we can help, I hope they will be healed, will get asylum. They say it is in God's hands and smile patiently, wearily, but still smile. I look around but I don't see God in these hallways. A petite, white 75 year old woman was turned away by the nurses because she needed a referral first... a referral from an inner city clinic where she could not go because she is old, and she is white. Racism? Realism. I would treat her, and I would treat a little old black lady just the same. But the nurses scowl, speak Zulu, and we turn away... white doctors, asian doctors, not black and not them. Us and Them. Is there racism in my country, a resident asks me. I'm not sure what to say... I shrug and reply there is injustice everywhere. So many patients, so much suffering, and hope? There is hope. I'm looking for it. Elizabeth is still barely responsive, moaning gently to pain but otherwise restless on her startched ICU sheets. I wonder what her morphine dreams look like. I continue to check on her, keep watching the respirator, keep waiting for God to decide.
I am working tonight. I drink dark Rooibos tea and try to lighten my mood, lighen my heart. Perhaps we can make a difference, even if it's just bandaids. If God is indeed here, then I hope he will lend a hand instead of only watching from the sidelines.
Monday, March 3, 2008
Bloody Hell, Mate, Bloody Hell.
It's hard to believe that less than a week has passed since I landed in Johannesburg... so much has happened already that it's difficult to keep track, even in my own mind, and harder still to reiterate it all on paper. For starters, I'm working crazy hours... this, of course, is mostly my own doing (we're required to work a minimum of 3 shifts per week, while I'm working 5-6), but although it's nearly impossible to roll out of bed in the morning (I swear, I don't sleep, I hibernate), once I'm actually at the hospital it's *fantastic*. As of this post, I've worked three 12 hour shifts so far... Sunday, Monday, and Tuesday afternoons. I took today off, and am going to be working Thursday, Friday, and Saturday nights this upcoming weekend (that's 6pm-7am). Since I'm only here for two months (well, working for two months, anyway!), I want to put in as much time on the trauma unit as possible to get the most out of it... though, honestly, even one day in Johannesburg is equivalent to about a month back home... the learning here curve is steep, but the rewards - skills, confidence, and of course adrenalin - are second to none.
The emergency rooms here are set up differently than in the US; due to the enormous volume of severe trauma (gun shot wounds, stab wounds, MVAs, train crashes, etc), the "major accidents" division is separate from the medical and pediatric units, which means that the only thing we see (non-stop), all shift long, is serious trauma. And although places like Camden, NJ and the Bronx boast high patient volumes, they don't even begin to compare with the insanity of Johannesburg. Even though apartheid ended over a decade ago, the terrible social and economic situation hasn't really changed for most black South Africans... if anything, because of the mass emigration of whites out of the country and re-distribution of jobs into not-so-competent hands, a great deal has gotten quite a bit worse. Widespread unemployment is contributing to social unrest, alcohol and drug abuse, and, inevitably, to violence (in poor areas like Soweto and Alexandria, unemployment is as high as 50%, and even higher amongst young adults). It seems that there's an ever-growing culture of violence... young men (and, occasionally, women) come in with brutal injuries from stabbings, shootings, beatings... there are constantly reports of random violence around the city, and the entire population seems to live in fear. Driving around, there are walls everywhere - 10 foot walls with electric fences and barbed wire, fancy surveillance systems, and guards. The poorer neighborhoods are a no-go for anyone not from there (and frankly I don't think the residents are particularly thrilled about it either); the culture of violence is driving a culture of fear and distrust, which, of course, perpetuates itself in a predictable cycle. Johannesburg is one of the worst cities in the world for all of this... which, I suppose, is exactly why I came here... so, to begin...
I was only scheduled to start this Monday, but after settling in on Saturday (I bought an electric tea pot and some local tea, called 'Rooibos', so I'm set :), I decided to go in for a few hours on Sunday to get oriented. Well, about 15 minutes in, my "orientation" was cut short by - what else? - a major trauma. Any time a seriously injured patient is brought in, somebody yells "resus!" (resuscitation), and everyone rushes over to one of the trauma bays in anticipation of their arrival. Although the physicians here are generally very well trained (and obviously, quite experienced), things don't always go smoothly, mostly due to equipment problems... for starters, most of the monitors don't work, there's only one (poorly) functioning manual blood pressure set, and supplies beyond the basic bandages, tapes, and tube sets are nearly non-existent. Just to give you an idea: the other day, we applied traction to a patient's femur fracture using several saline bags in a plastic garbage bag, tied to the end of his splint! And this is a level one trauma hospital in a major city... and apparently, things used to be even worse. Anyway, so getting back to this patient... as this was my first resus, I stood back to watch the flow of things... another elective student, Colin (a Scotsman from the UK) started an IV drip while the two docs intubated the patient, drew gases, and started a central line... all in minutes. It was honestly kind of like ER but, well, real. Very real. Unfortunately, this patient actually had to be resuscitated in a procedure cubicle instead of a major resus bay... why? Because the resus bays were all being used to monitor post-op ICU patients! That's right folks, critical ICU patients - on vents and all - were being monitored in the emergency department by a skeleton nursing staff... and displacing the trauma patients coming in to surrounding bays and, well, the hallway (The ICU - and the entire hospital in general - is terribly overcrowded and patients who need intensive montoring are constantly spilling over into the ERs...) In any case, halfway though the resuscitation, the physician placing a chest tube suddenly got a massive shot of bright red blood all over his scrubs... all was quiet for a moment, and then the startled doc shrugged and said "oh, bloody hell, mate!" and continued on. To survive this place, you have to be laid-back about pretty much everything, or else you just won't make it.
My 36 hours of work have been busy, incredibly rewarding, and, admittedly, a bit sobering. I'm doing my best to cope - the long hours, wide array of accents (I think I'm starting to sound a bit British?), different culture, city, names for things... and, of course, the ever-present undercurrent of tension that is steadily, constantly palpable. So far, I've placed a chest tube, assisted with a central line, set up countless IVs and drawn more ABGs than I can count, and sutured like crazy. Yesterday I had a marathon suturing session - an hour and a half of standing, straining, and threading, with a woman named Elizabeth. Elizabeth is a black maid from Soweto who works in an upper-middle class suburb of Johannesburg. She was on her way to work yesterday morning when she was hit by a speeding car, apparently flipped over the roof and was thrown down onto the pavement. She was airlifted out and brought to our trauma bay in severe hypovolemic shock, with a broken femur, head injury, and massive degloving injury of the scalp. Once she was stabilized (somehow, amidst the chaos, we do manage to save some people...), I was given the job of suturing her. Now, I can't stress enough how difficult it is to neatly suture up a degloving injury, particularly one in a highly vascular area like the scalp; back in the US, even a senior EM doctor probably wouldn't do it, instead leaving it to an experienced plastic surgeon. But, of course, this is Africa, and I was the best we had. Elizabeth was heavily sedated, but sometimes patients can hear what's going on around them anyway, so, I guess for lack of any better ideas, I spoke to her while I sutured. I told her what I was about to do and why, explaining the procedure and promising to do my best. The longer I stood there, the more, well, human she became to me... even with all of those tubes, bandages, and bright lights, even with the swollen face and broken teeth, she somehow reminded me of, well, any middle-aged woman... it could happen to anyone. I thought about my family - what kind of care would I want my mother to get in such a situation? I spent a lot of time suturing Elizabeth, thinking... when the orthopedics intern introduced her to the attending as an "unknown female", I hastily corrected her; It became important to me that she was recognized for who she was - Elizabeth, a maid from Soweto, with a husband and two young children. Probably because she wasn't just another gangbanger or thief, but just an ordinary person trying to go about her life, I was willing to see her as more than just a body to resuscitate... it's dangerous, perhaps, to get attached to patients, but I think it's also what makes you a good physician. I checked on her this afternoon, looking a bit better and now in a proper ICU bed upstairs; She'll live (though the extent of her brain injury is still unknown), and, hopefully, she'll like her forehead when she finally looks in the mirror. It's a small thing, I know, but then it's the small things that, bit by bit, make me feel that - at least once in a while - I can make a difference, and perhaps through that contribution, make sense of the chaos that is otherwise overwhelming in its senselessness.
I'm learning so much here - about medicine, people, politics, and, as always, about myself - I made friends with Colin (who happens to have a car! yay :), and his landlady's dog, so I have company... we're spending our days off exploring the city; I went out to dinner in Melville yesterday, walked around the Johannesburg Zoo today, and am working on organizing a walking or cycling tour of Soweto for next week. The next few days are going to be hectic, but I will definitely update the blog again on Sunday, once i've caught up on sleep... and, as always, I will continue to post up more photographs! Below are three from the safari days... my god, that feels like a lifetime ago...
Relaxing at Lake Manyara, Tanzania
Photographer on assignment! :)
Photographing up close (I need a longer lens!) in the Serengeti... this bird wandered around our campsite, scavenging for food...
The emergency rooms here are set up differently than in the US; due to the enormous volume of severe trauma (gun shot wounds, stab wounds, MVAs, train crashes, etc), the "major accidents" division is separate from the medical and pediatric units, which means that the only thing we see (non-stop), all shift long, is serious trauma. And although places like Camden, NJ and the Bronx boast high patient volumes, they don't even begin to compare with the insanity of Johannesburg. Even though apartheid ended over a decade ago, the terrible social and economic situation hasn't really changed for most black South Africans... if anything, because of the mass emigration of whites out of the country and re-distribution of jobs into not-so-competent hands, a great deal has gotten quite a bit worse. Widespread unemployment is contributing to social unrest, alcohol and drug abuse, and, inevitably, to violence (in poor areas like Soweto and Alexandria, unemployment is as high as 50%, and even higher amongst young adults). It seems that there's an ever-growing culture of violence... young men (and, occasionally, women) come in with brutal injuries from stabbings, shootings, beatings... there are constantly reports of random violence around the city, and the entire population seems to live in fear. Driving around, there are walls everywhere - 10 foot walls with electric fences and barbed wire, fancy surveillance systems, and guards. The poorer neighborhoods are a no-go for anyone not from there (and frankly I don't think the residents are particularly thrilled about it either); the culture of violence is driving a culture of fear and distrust, which, of course, perpetuates itself in a predictable cycle. Johannesburg is one of the worst cities in the world for all of this... which, I suppose, is exactly why I came here... so, to begin...
I was only scheduled to start this Monday, but after settling in on Saturday (I bought an electric tea pot and some local tea, called 'Rooibos', so I'm set :), I decided to go in for a few hours on Sunday to get oriented. Well, about 15 minutes in, my "orientation" was cut short by - what else? - a major trauma. Any time a seriously injured patient is brought in, somebody yells "resus!" (resuscitation), and everyone rushes over to one of the trauma bays in anticipation of their arrival. Although the physicians here are generally very well trained (and obviously, quite experienced), things don't always go smoothly, mostly due to equipment problems... for starters, most of the monitors don't work, there's only one (poorly) functioning manual blood pressure set, and supplies beyond the basic bandages, tapes, and tube sets are nearly non-existent. Just to give you an idea: the other day, we applied traction to a patient's femur fracture using several saline bags in a plastic garbage bag, tied to the end of his splint! And this is a level one trauma hospital in a major city... and apparently, things used to be even worse. Anyway, so getting back to this patient... as this was my first resus, I stood back to watch the flow of things... another elective student, Colin (a Scotsman from the UK) started an IV drip while the two docs intubated the patient, drew gases, and started a central line... all in minutes. It was honestly kind of like ER but, well, real. Very real. Unfortunately, this patient actually had to be resuscitated in a procedure cubicle instead of a major resus bay... why? Because the resus bays were all being used to monitor post-op ICU patients! That's right folks, critical ICU patients - on vents and all - were being monitored in the emergency department by a skeleton nursing staff... and displacing the trauma patients coming in to surrounding bays and, well, the hallway (The ICU - and the entire hospital in general - is terribly overcrowded and patients who need intensive montoring are constantly spilling over into the ERs...) In any case, halfway though the resuscitation, the physician placing a chest tube suddenly got a massive shot of bright red blood all over his scrubs... all was quiet for a moment, and then the startled doc shrugged and said "oh, bloody hell, mate!" and continued on. To survive this place, you have to be laid-back about pretty much everything, or else you just won't make it.
My 36 hours of work have been busy, incredibly rewarding, and, admittedly, a bit sobering. I'm doing my best to cope - the long hours, wide array of accents (I think I'm starting to sound a bit British?), different culture, city, names for things... and, of course, the ever-present undercurrent of tension that is steadily, constantly palpable. So far, I've placed a chest tube, assisted with a central line, set up countless IVs and drawn more ABGs than I can count, and sutured like crazy. Yesterday I had a marathon suturing session - an hour and a half of standing, straining, and threading, with a woman named Elizabeth. Elizabeth is a black maid from Soweto who works in an upper-middle class suburb of Johannesburg. She was on her way to work yesterday morning when she was hit by a speeding car, apparently flipped over the roof and was thrown down onto the pavement. She was airlifted out and brought to our trauma bay in severe hypovolemic shock, with a broken femur, head injury, and massive degloving injury of the scalp. Once she was stabilized (somehow, amidst the chaos, we do manage to save some people...), I was given the job of suturing her. Now, I can't stress enough how difficult it is to neatly suture up a degloving injury, particularly one in a highly vascular area like the scalp; back in the US, even a senior EM doctor probably wouldn't do it, instead leaving it to an experienced plastic surgeon. But, of course, this is Africa, and I was the best we had. Elizabeth was heavily sedated, but sometimes patients can hear what's going on around them anyway, so, I guess for lack of any better ideas, I spoke to her while I sutured. I told her what I was about to do and why, explaining the procedure and promising to do my best. The longer I stood there, the more, well, human she became to me... even with all of those tubes, bandages, and bright lights, even with the swollen face and broken teeth, she somehow reminded me of, well, any middle-aged woman... it could happen to anyone. I thought about my family - what kind of care would I want my mother to get in such a situation? I spent a lot of time suturing Elizabeth, thinking... when the orthopedics intern introduced her to the attending as an "unknown female", I hastily corrected her; It became important to me that she was recognized for who she was - Elizabeth, a maid from Soweto, with a husband and two young children. Probably because she wasn't just another gangbanger or thief, but just an ordinary person trying to go about her life, I was willing to see her as more than just a body to resuscitate... it's dangerous, perhaps, to get attached to patients, but I think it's also what makes you a good physician. I checked on her this afternoon, looking a bit better and now in a proper ICU bed upstairs; She'll live (though the extent of her brain injury is still unknown), and, hopefully, she'll like her forehead when she finally looks in the mirror. It's a small thing, I know, but then it's the small things that, bit by bit, make me feel that - at least once in a while - I can make a difference, and perhaps through that contribution, make sense of the chaos that is otherwise overwhelming in its senselessness.
I'm learning so much here - about medicine, people, politics, and, as always, about myself - I made friends with Colin (who happens to have a car! yay :), and his landlady's dog, so I have company... we're spending our days off exploring the city; I went out to dinner in Melville yesterday, walked around the Johannesburg Zoo today, and am working on organizing a walking or cycling tour of Soweto for next week. The next few days are going to be hectic, but I will definitely update the blog again on Sunday, once i've caught up on sleep... and, as always, I will continue to post up more photographs! Below are three from the safari days... my god, that feels like a lifetime ago...
Relaxing at Lake Manyara, Tanzania
Photographer on assignment! :)
Photographing up close (I need a longer lens!) in the Serengeti... this bird wandered around our campsite, scavenging for food...
Me with Maureen in Tanzania (the daughter of the teacher/ ice cream maker)
Saturday, March 1, 2008
Photographs!
I've been trying to upload my photographs to this blog, but that feature doesn't seem to be working at the moment (or it just doesn't like me - hard to tell). Instead, i've uploaded some of them to my account at pbase; you can access it by following this link: http://www.pbase.com/quideam and then click on "Travels Through Tanzania". I'm going to be posting a lot more photographs in the coming days, so stay tuned!
A Johannesburg welcome, ay
Although my flight into Johannesburg arrived 20 minutes early, it by no means set a precident... actually, it probably set the bar a little high. During the 3 hour flight, I met a really nice (though slightly bitter?) South African businessman, Shamus (yes, he's also an Irish national...). He was so friendly that the spent the entire flight telling me about anecdotal rapes, muggings, stabbings... you get the picture. I also got a healthy dose of pro-apartheid era propaganda... although even I have to admit that some of what he said seemed to ring true. I'm going to delve into this topic (inevitably, i suppose) more and more as I adjust to South Africa, so I don't want to start off on a tangent now. However, the consensus amongst white South Africans seems to be that there's now a great deal of reverse-racism, which, in addition to being frustrating, has also resulted in a gradual weakening of institutions, deteriorating infrastructure, and overall incompetence as the previously educated (and white) leadership has been mostly replaced with hand-picked blacks who, in a lot of cases, aren't qualified for the job. A prime example of this would be the minister of health, Manto Tshabalala-Msimang, who in February announced that HIV patients don't need anti-retrovirals, and can instead be cured by using a combination of garlic, olive oil and beet juice (http://www.voanews.com/english/archive/2007-08/2007-08-14-voa19.cfm?CFID=23414950&CFTOKEN=65465016). Aside from frustrations, these issues bring up another question worth a good deal of consideration: How do countires that have been ruled by colonialism transition into effective self-rule? Is rapid modernization even possible in these circumstances, or are such societies inevitably going to descend into (hopefully temporary) chaos? I'll write more on this later... for now, back to my flight...
When the plane landed, Shamus called my contact at the university to make sure that he was already at the airport... ha, yeah, I guess we all knew that it was a long shot. Nicholas, the driver, was nowhere to be found and said he would "call me back"... yikes. I retreived my bags, and Shamus offered to drive me to the Wits campus. Well, his wife (whose accent I could barely understand, ay) met us... in a Porsche! I have to say, that ride was much better than a beat-up minivan would have been :). The were incredibely nice to me - they drove me to an ATM, a restaurant to pick up dinner, and helped carry my bags upstairs to my room. My room is a single (yay!), though with a shared bathroom down the hallway... I have yet to see anyone else using the bathroom, however, so either this particular wing is nearly empty, or there's a second magical toilet I don't yet know about... either way, everything is clean and fairly new, so no complaints.
After moving in (read: randomly throwing clothing around the room), I had one more small matter to take care of. About a week ago, my sandals caused a cut between my big and second toes on my right leg... by Thursday, the cut had mostly healed, but a small abscess had formed in its' place. I had been waiting to see if it would resorb on its own, but by the evening it was slightly painful and the area around it was red and tender... so, I decided, time to break out the first aid kit and do a little self-surgery.
The procedure: draining abscess, maintaining as much sterility as possible under the circumstances
Equipment: safety pin (to puncture the abscess), lighter (to sterilize the safety pin), not-so-sterile tissues, and a small tube of neosporin.
I won't go into details, but it went well... it's Saturday night now, and the cut has dried up and is healing pretty well. And yes, i'm still wearing the sandals! It's hot here, damn it.
Alright, i'm off to sleep... it's been a long day, and i'll write more tomorrow. I start my first shift at 8am, and I still need to go and "iron" (read: flatten out and pray) my scrubs and find my stethescope...
When the plane landed, Shamus called my contact at the university to make sure that he was already at the airport... ha, yeah, I guess we all knew that it was a long shot. Nicholas, the driver, was nowhere to be found and said he would "call me back"... yikes. I retreived my bags, and Shamus offered to drive me to the Wits campus. Well, his wife (whose accent I could barely understand, ay) met us... in a Porsche! I have to say, that ride was much better than a beat-up minivan would have been :). The were incredibely nice to me - they drove me to an ATM, a restaurant to pick up dinner, and helped carry my bags upstairs to my room. My room is a single (yay!), though with a shared bathroom down the hallway... I have yet to see anyone else using the bathroom, however, so either this particular wing is nearly empty, or there's a second magical toilet I don't yet know about... either way, everything is clean and fairly new, so no complaints.
After moving in (read: randomly throwing clothing around the room), I had one more small matter to take care of. About a week ago, my sandals caused a cut between my big and second toes on my right leg... by Thursday, the cut had mostly healed, but a small abscess had formed in its' place. I had been waiting to see if it would resorb on its own, but by the evening it was slightly painful and the area around it was red and tender... so, I decided, time to break out the first aid kit and do a little self-surgery.
The procedure: draining abscess, maintaining as much sterility as possible under the circumstances
Equipment: safety pin (to puncture the abscess), lighter (to sterilize the safety pin), not-so-sterile tissues, and a small tube of neosporin.
I won't go into details, but it went well... it's Saturday night now, and the cut has dried up and is healing pretty well. And yes, i'm still wearing the sandals! It's hot here, damn it.
Alright, i'm off to sleep... it's been a long day, and i'll write more tomorrow. I start my first shift at 8am, and I still need to go and "iron" (read: flatten out and pray) my scrubs and find my stethescope...
Friday, February 29, 2008
36 Hours in Zanzibar
3:45pm Arrive at Dar es Salaam ferry station with two giant bags and just barely enough time to make it to the terminal... Get overcharged for the ticket but, finally, board successfully.
6:30pm Disembark in Zanzibar, slightly sea sick and very tired, but, after almost 15 hours of travel THAT DAY, at least I'm there. Take a taxi to Jambo Guest House, which only has triples... drag bags to two more hotels until finally, one is available... give up and unpack. This, um, 'hotel' (very loosely speaking) is called Annexe of Abdullah; It's clean enough, but very hot (with no fans!) and the bathroom faintly reeks of urine... yum.
8:00pm Time to find dinner... the restaurant I picked from my guidebook didn't seem to exist... "settled" for an amazing Italian restaurant called "La Fencie"... mmmm... beef and vegatable lasagnia... finish off the dinner with strawberry and mint chocolate chip ice cream from an Italian cafe across the street. Thank goodness for all the expats setting up shops abroad! Hmm, maybe I should actually go to Italy next time?
10:00pm Wander around a bit, looking for my hotel... Zanzibar's streets are a mess of narrow winding alleyways and crumbling mansions, making finding anything incredibely difficult. Evenutally I stumbled across a really beautiful guesthouse with rosebushes out front, appropriately named "Garden Lodge"; Their security guard walked me 'home' (which turned out to be five minutes away), and I decided that I would switch to the Garden Lodge the next morning.
11:00pm Lay in bed watching reruns of M*A*S*H and the A-Team... fall asleep sometime after midnight to the sounds of Arabic music still playing outside...
8:00am Convince the hotel owner that I do, in fact, want to move to a different guesthouse... for $10 extra, I can have a bigger bed and a private bathroom that, thankfully, doesn't smell like anything, and particularly not like... well, you get the point. Drag bags over to the Garden Lodge and climb the winding staircase up to the roof terrace just in time for brekfast. Perfect!
10:00am Camera slung over shoulder, hair loosely covered with a thin gold-colored scarf, venture outside to begin photographing. I spent the afternoon wandering through streets and alleyways, sometimes sneaking pictures and other times getting permission... surprisingly, most people were happy (or at least willing) to pose for pictures; the key seems to be to hang out with them for a bit first, introduce yourself, show them some of your other photographs... even the religious women were willing to loosen their headscarves a bit and let me take a picture. I'm not sure how well they're going to turn out, but at least it was good practice...
6:00pm Dinner at "Mercury's", a candlelit seafood restaurant overlooking the water. It's named after Freddy Mercury, who was born in Zanzibar... took some more photographs, mostly of the ships leaving harbor and the sunset.
9:00pm Wander through the night market... i'm sure that this used to be a really authentic Zanzibari experience, but with so many tourists around it's become very commercialized, expensive, and more of a hassle than anything else. I bought some overpriced fruit and settled down on a small wooden bench; I was quickly joined by a local ice cream vendor and his baby monkey, named Cobra. This, of course, attracted a lot of attention, and I made friends with two Israelis who were traveling through; oddly, compared to India, there are almost no Israelis around... I'm starting to miss advertisements for samosas in poorly-written Hebrew! Came back home around midnight, packed up the remainder of my things, and passed out, hoping not to oversleep for tomorrow's 7am trip back to Dar es Salaam...
6:15am Wake up in a panic, because I was supposed to be in a taxi 15 minutes ago! Scramble to get ready, hop in a taxi about 10 (yes 10!) minutes later, and arrive at the dock with more than enough time (this is african time, after all... the immigration window wasn't even open yet...). Luckily, I met a Norwegian guy, Jonas, who I ended up chatting with during the boat ride; He kindly dragged my giant duffel bag on and off the ferry, and then several blocks further to a little lunch spot. Then, goodbye Tanzania! Off to the airport... 
6:30pm Disembark in Zanzibar, slightly sea sick and very tired, but, after almost 15 hours of travel THAT DAY, at least I'm there. Take a taxi to Jambo Guest House, which only has triples... drag bags to two more hotels until finally, one is available... give up and unpack. This, um, 'hotel' (very loosely speaking) is called Annexe of Abdullah; It's clean enough, but very hot (with no fans!) and the bathroom faintly reeks of urine... yum.
8:00pm Time to find dinner... the restaurant I picked from my guidebook didn't seem to exist... "settled" for an amazing Italian restaurant called "La Fencie"... mmmm... beef and vegatable lasagnia... finish off the dinner with strawberry and mint chocolate chip ice cream from an Italian cafe across the street. Thank goodness for all the expats setting up shops abroad! Hmm, maybe I should actually go to Italy next time?
10:00pm Wander around a bit, looking for my hotel... Zanzibar's streets are a mess of narrow winding alleyways and crumbling mansions, making finding anything incredibely difficult. Evenutally I stumbled across a really beautiful guesthouse with rosebushes out front, appropriately named "Garden Lodge"; Their security guard walked me 'home' (which turned out to be five minutes away), and I decided that I would switch to the Garden Lodge the next morning.
11:00pm Lay in bed watching reruns of M*A*S*H and the A-Team... fall asleep sometime after midnight to the sounds of Arabic music still playing outside...
8:00am Convince the hotel owner that I do, in fact, want to move to a different guesthouse... for $10 extra, I can have a bigger bed and a private bathroom that, thankfully, doesn't smell like anything, and particularly not like... well, you get the point. Drag bags over to the Garden Lodge and climb the winding staircase up to the roof terrace just in time for brekfast. Perfect!
10:00am Camera slung over shoulder, hair loosely covered with a thin gold-colored scarf, venture outside to begin photographing. I spent the afternoon wandering through streets and alleyways, sometimes sneaking pictures and other times getting permission... surprisingly, most people were happy (or at least willing) to pose for pictures; the key seems to be to hang out with them for a bit first, introduce yourself, show them some of your other photographs... even the religious women were willing to loosen their headscarves a bit and let me take a picture. I'm not sure how well they're going to turn out, but at least it was good practice...
6:00pm Dinner at "Mercury's", a candlelit seafood restaurant overlooking the water. It's named after Freddy Mercury, who was born in Zanzibar... took some more photographs, mostly of the ships leaving harbor and the sunset.
9:00pm Wander through the night market... i'm sure that this used to be a really authentic Zanzibari experience, but with so many tourists around it's become very commercialized, expensive, and more of a hassle than anything else. I bought some overpriced fruit and settled down on a small wooden bench; I was quickly joined by a local ice cream vendor and his baby monkey, named Cobra. This, of course, attracted a lot of attention, and I made friends with two Israelis who were traveling through; oddly, compared to India, there are almost no Israelis around... I'm starting to miss advertisements for samosas in poorly-written Hebrew! Came back home around midnight, packed up the remainder of my things, and passed out, hoping not to oversleep for tomorrow's 7am trip back to Dar es Salaam...
6:15am Wake up in a panic, because I was supposed to be in a taxi 15 minutes ago! Scramble to get ready, hop in a taxi about 10 (yes 10!) minutes later, and arrive at the dock with more than enough time (this is african time, after all... the immigration window wasn't even open yet...). Luckily, I met a Norwegian guy, Jonas, who I ended up chatting with during the boat ride; He kindly dragged my giant duffel bag on and off the ferry, and then several blocks further to a little lunch spot. Then, goodbye Tanzania! Off to the airport...
Girls by a doorway, Zanzibar
Wednesday, February 27, 2008
Better Than Ice Cream
Tanzania has turned out to be quite a whirlwind of, well, everything... new friends, wandering elephants, food, ferries, photography... i'm having an incredible time! Here's a quick summary of the days after the safari (I swear i'm posting photographs soon!)
Saturday, February 23rd
Returning from our four day safari, I had fully intended to book an early ticket for the Dar Express for Saturday morning, but instead decided to give Arusha one more day... maybe it was the warm Kilimanjaro beer, or possibly Olivier's promise that we would do something "really interesting" on Saturday... anyway, I stayed. Saturday morning, after a small breakfast and thick, dark Tanzanian coffee (I'm constantly amazed at the food here.... it's a far cry from my cheese toast days in Palghar!), we headed off. To say that we had a plan would be a gross overstatement... basically, after getting to the town square (indicated by an intricately carved clock tower and large elephant statue), we hopped on the first available dalla-dalla (overcrowded minivan) and vowed to take it to the last stop. After about 20 sweaty, occasionally hair-rasing minutes, we disembarked on what must have been the main street of a village just outside of Arusha. Dusting off, we unpacked our cameras and began walking... snapping photos alongside Olivier, I felt like a real photographer :). It was difficult at first... a lot of people didn't want their photograph taken or demanded money; several women followed us, yelling. But eventually we found some children who thought we were hysterical, and after half an hour with them, we settled down in a shady spot for a break. Sitting across from a fantastic background (a light brown, crumbling building with painted green windows), we waited for people to stop or walk by, being as inconspicuous as possible. A few minutes into this, an adorable little girl - she was about 10 - sat down next to me and very confidently asked my name. She turned out to speak fluent English (!!), and invited us to meet her father. Intrigued by this adorable girl with a faint British accent, we obliged...
Following her, we entered a tiny two-room apartment and were welcomed into the makeshift kitchen (several buckets and an electric stove top, partitioned from the living room by a plastic tarp). Her father, shirtless and Buddha-bellied, sat on a short stool straining colored water; He welcomed us warmly. Samuel is a schoolteacher; he's fluent in English and received a university degree in Dar Es Salaam. However, as a teacher, he makes less than $200 per month - not enough to take care of his family and send his two daughters to a decent school. So, on the side, he makes and sells ice cream (his wife has a small cart that she takes to schools and nearby markets). With this, they're able to make an additional $40-50 per month - more than a quarter of his regular income! This, sadly, reminded me of my own father... back in Ukraine, even though he was a university-trained engineer, working full time, he barely made enough to make ends meet. So, o the side, he would illegally import wallpaper from Poland and the Check Republic, and spent the weekends pasting it in apartments around Kiev. It's nothing short of a tragedy that these critical professionals - teachers, doctors, engineers - continue to get such horribly low wages, forcing them to take on side-jobs instead of focusing fully on their work. Tanzania may not be the former USSR, but watching Samuel straining water... well, corrupt government and ridiculous social policies have the same impact on any continent.
Samuel and his daughters walked us back to Masai camp, stopping along the way to let us (and often help us) take photographs... the older daughter, Maureen, was incredibly brave and asked me outright if I would teach her to use my camera! A few minutes later, this tiny little girl was clicking away - and doing a pretty good job! I guess anyone can be a photographer :). Olivier got some great shots of her taking photographs - I'll post those up as well (soon, I promise!). Samuel invited us to come to his school on Monday, and... well, how could I refuse? So that's how I ended up staying in Arusha for yet another two days... thank goodness for copious beer, thick pizzas, and loud rock music at Masai camp to keep me, um, occupied...
Monday, February 25th
Olivier and I were both feeling sick this morning... it was probably just the heat, but we agreed to take it easy. Somehow this translated into an hour walk in the scorching sun (!!) in search of a photo shop (we wanted to print out some of Maureen's photographs as a gift). Eventually we found it (but had basically walked a giant, unnecessary loop). We then caught a taxi to Samuel's school... and were shocked. This IS Africa, after all... we came expecting dilapidated buildings and dirty children... what we found instead were neat, freshly-painted classrooms, giant blackboards, and well-fed little kids running around in navy uniforms. Samuel explained that this was a fairly elite private school, primarily with Indian children (over the past 50 years, Indians have formed a small but prosperous community in Tanzania, running many of the shops and financial institutions). Samuel's daughters could go here for free, but would then be unlikely to get into secondary school (you can only go to certain secondary schools based on where you went to primary school, and this one only led to expensive options that would be unaffordable to him). So instead, he pays $90 per month for each daughter to attend an all-African school, where, unlike this one, they have to share desks, chairs, and even notebooks. We would have gone to visit them as well but I was really feeling hot and exhausted by this time, so we headed back to camp. Aside from a few photographs, I managed to take away yet another lesson from Africa - not everything is what you would expect, but then sometimes, it is. I hope, at the least, that Maureen likes the photographs... a part of me wanted to stay and help somehow, but then what can I do? I will leave, and Africa will continue on as it always has.
Tuesday, February 26th - Wednesday, February 27th
Finally, after an extra 3 days in Arusha, I caught the 6am bus (the right one this time!) for Dar es Salaam. The bus ride went smoothly (no chickens this time), and I arrived at the port with enough time to catch the 4:15 ferry for Zanzibar. Now, astute readers will note that this means I have about 36 hours in Zanzibar before I have to take the ferry back over to Dar and fly out to Johannesburg Thursday afternoon... so, in New York Times fashion, my next post will be infamously named: 36 Hours in Zanzibar. Until then, good night!
Samuel with his daughters, making ice cream; Arusha, Tanzania
Saturday, February 23rd
Returning from our four day safari, I had fully intended to book an early ticket for the Dar Express for Saturday morning, but instead decided to give Arusha one more day... maybe it was the warm Kilimanjaro beer, or possibly Olivier's promise that we would do something "really interesting" on Saturday... anyway, I stayed. Saturday morning, after a small breakfast and thick, dark Tanzanian coffee (I'm constantly amazed at the food here.... it's a far cry from my cheese toast days in Palghar!), we headed off. To say that we had a plan would be a gross overstatement... basically, after getting to the town square (indicated by an intricately carved clock tower and large elephant statue), we hopped on the first available dalla-dalla (overcrowded minivan) and vowed to take it to the last stop. After about 20 sweaty, occasionally hair-rasing minutes, we disembarked on what must have been the main street of a village just outside of Arusha. Dusting off, we unpacked our cameras and began walking... snapping photos alongside Olivier, I felt like a real photographer :). It was difficult at first... a lot of people didn't want their photograph taken or demanded money; several women followed us, yelling. But eventually we found some children who thought we were hysterical, and after half an hour with them, we settled down in a shady spot for a break. Sitting across from a fantastic background (a light brown, crumbling building with painted green windows), we waited for people to stop or walk by, being as inconspicuous as possible. A few minutes into this, an adorable little girl - she was about 10 - sat down next to me and very confidently asked my name. She turned out to speak fluent English (!!), and invited us to meet her father. Intrigued by this adorable girl with a faint British accent, we obliged...
Following her, we entered a tiny two-room apartment and were welcomed into the makeshift kitchen (several buckets and an electric stove top, partitioned from the living room by a plastic tarp). Her father, shirtless and Buddha-bellied, sat on a short stool straining colored water; He welcomed us warmly. Samuel is a schoolteacher; he's fluent in English and received a university degree in Dar Es Salaam. However, as a teacher, he makes less than $200 per month - not enough to take care of his family and send his two daughters to a decent school. So, on the side, he makes and sells ice cream (his wife has a small cart that she takes to schools and nearby markets). With this, they're able to make an additional $40-50 per month - more than a quarter of his regular income! This, sadly, reminded me of my own father... back in Ukraine, even though he was a university-trained engineer, working full time, he barely made enough to make ends meet. So, o the side, he would illegally import wallpaper from Poland and the Check Republic, and spent the weekends pasting it in apartments around Kiev. It's nothing short of a tragedy that these critical professionals - teachers, doctors, engineers - continue to get such horribly low wages, forcing them to take on side-jobs instead of focusing fully on their work. Tanzania may not be the former USSR, but watching Samuel straining water... well, corrupt government and ridiculous social policies have the same impact on any continent.
Samuel and his daughters walked us back to Masai camp, stopping along the way to let us (and often help us) take photographs... the older daughter, Maureen, was incredibly brave and asked me outright if I would teach her to use my camera! A few minutes later, this tiny little girl was clicking away - and doing a pretty good job! I guess anyone can be a photographer :). Olivier got some great shots of her taking photographs - I'll post those up as well (soon, I promise!). Samuel invited us to come to his school on Monday, and... well, how could I refuse? So that's how I ended up staying in Arusha for yet another two days... thank goodness for copious beer, thick pizzas, and loud rock music at Masai camp to keep me, um, occupied...
Monday, February 25th
Olivier and I were both feeling sick this morning... it was probably just the heat, but we agreed to take it easy. Somehow this translated into an hour walk in the scorching sun (!!) in search of a photo shop (we wanted to print out some of Maureen's photographs as a gift). Eventually we found it (but had basically walked a giant, unnecessary loop). We then caught a taxi to Samuel's school... and were shocked. This IS Africa, after all... we came expecting dilapidated buildings and dirty children... what we found instead were neat, freshly-painted classrooms, giant blackboards, and well-fed little kids running around in navy uniforms. Samuel explained that this was a fairly elite private school, primarily with Indian children (over the past 50 years, Indians have formed a small but prosperous community in Tanzania, running many of the shops and financial institutions). Samuel's daughters could go here for free, but would then be unlikely to get into secondary school (you can only go to certain secondary schools based on where you went to primary school, and this one only led to expensive options that would be unaffordable to him). So instead, he pays $90 per month for each daughter to attend an all-African school, where, unlike this one, they have to share desks, chairs, and even notebooks. We would have gone to visit them as well but I was really feeling hot and exhausted by this time, so we headed back to camp. Aside from a few photographs, I managed to take away yet another lesson from Africa - not everything is what you would expect, but then sometimes, it is. I hope, at the least, that Maureen likes the photographs... a part of me wanted to stay and help somehow, but then what can I do? I will leave, and Africa will continue on as it always has.
Tuesday, February 26th - Wednesday, February 27th
Finally, after an extra 3 days in Arusha, I caught the 6am bus (the right one this time!) for Dar es Salaam. The bus ride went smoothly (no chickens this time), and I arrived at the port with enough time to catch the 4:15 ferry for Zanzibar. Now, astute readers will note that this means I have about 36 hours in Zanzibar before I have to take the ferry back over to Dar and fly out to Johannesburg Thursday afternoon... so, in New York Times fashion, my next post will be infamously named: 36 Hours in Zanzibar. Until then, good night!
Samuel with his daughters, making ice cream; Arusha, Tanzania
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