1 October 2007
I have arrived safely in Mthatha, South Africa and expect the rest of my luggage to do the same tomorrow!

It is Monday night and I am in the house where I will live for the next few weeks. It is a little 2 bedroom brick house in the “compound” of Bedford Orthopedic Hospital. When I figure out how, I will try to post some pictures. I have a roommate named Megan from Manchester, England. She is a very nice young woman working here as a physiotherapist (aka physical therapist) for 6 months.

I will work in the Nelson Mandela Hospital. I spent most of today there and I have already seen amazing disease processes. The style of delivering medicine is so different but the medical care itself seems the same so far. This is the place where those who cannot afford care come from the entire area. They have diseases that reflect their poverty and lack of access to preventive care. They are amazingly patient and grateful for the care they receive.

2 October 2007
The luggage has arrived! It seems to be all intact.

There were some patients who had surgery canceled today so they told me to take the day and get settled. So I picked up the luggage and started to find my way around town and pick up a few supplies.

There was a bad accident not far from here this morning. People drive in very reckless ways and many of the vehicles are loaded with people in the back of pickups and very full minivans. They often stand by the side of the road, well sort of to the side, and are waiting for someone to pick them up. It appears to be an unofficial taxi system. They are expected to pay a small amount for the ride. The driving here reminds me of Ireland only far worse. The roads are worse, the rules are not clear when they exist and seem to be only guidelines. One of the Harrington boys refers to stop signs as ‘stoptional’ signs and that appears to be accurate. Stoplights seem to mean that only 1 or 2 cars may go after it turns red.

It is cool in the evenings and has been getting warm during the days. It rained last night. The house seems humid but the surrounding land looks very dry. Tonight there was a series of downpours. We lost power 3 times so far. We keep candles set around all the time. I hope the Harringtons stayed dry. They live in a rondoval which is a house with a thatched roof.

I had dinner with Ed and Caroline and 2 of the other volunteers. Jesse is here for a year, I believe. He was born in Canada and grew up in the states. He has a degree n political science and a master’s degree that I think is in international relations. Robert is here from Leipzig Germany. He is in college studying social work and I suspect he has had more experience here than you can imagine. He returns to school next week for his final year. They both work at a community center outside of town that was literally built on a garbage dump. It has approximately 3000 residents and is growing. The center provides some primary medical care, child care and support for all kinds of problems for these people.


3 October 2007
This morning we started with morning review of patients admitted overnight. Then the bedside rounds started and I met the medical students there. No AC so it gets very hot for pts and staff. It is the first wk of a six week rotation in OBGYN for these students. They are 5th yr students. Med school is 5yrs here; starting directly after high school. Apparently most schools have gone from 7yrs to 6yrs and a few to 5 but they then do a required general intern yr before deciding on a specialty. Rounds are similar with student presenting and staff questioning and critiquing, but done at the bedside as if the pt was not there. It is done in English and therefore most pts don't understand what is spoken and seem to sleep through most of it. Students are timid, so very soft spoken, making it even harder to understand their British style South African accents,

Lunch at the cafeteria: beans, rice, meat, carrots and peas +soda for R13 (less than $2). The only choice is whether you eat it all of it. They fill the plates the same for everyone. It’s interesting that as I look around it suddenly occurs to me that I am the only white person in the cafeteria and I haven't seen another white person today since leaving the house.

There is no recycling here. It is so difficult to throw away cans, bottles etc. I wonder if they recycle in the cities although I didn't see any during our overnight in Jo'burg, as they call Johannesburg. Among other things this is probably contributing to the littering. I simply cannot describe the trash on the roadside and almost everywhere. I don’t think I would have believed the degree without seeing it. You will have to see the pictures when I get them up here.

It appears that they are going to let me do some teaching which I will like and students and residents are very interested in any help they can get. Tomorrow I will talk to a doctor who does most of the fistula surgery and arrange to work with him. Unfortunately it is a growing problem so I will get some experience. There are 2 OB pts who are very complicated and the residents seemed so grateful when I offered to help. One is an insulin dependent diabetic whose DM control seems to be hospitalization for 1 day per week for a series of glucose tests followed by the insulin dose schedule for the week which is adjusted in between by “how she feels”. The other is a pt with twins at 26 weeks with polyhydramnios. They tell me her AFI is 52. She couldn’t tell me if this is is diamnionic or monoamnionic. In fact she can’t see the 2nd twin any more when she scanned her and she hasn’t had an attending with time to help her scan this week. She wants my help. That ought to make Stan laugh!

All the volunteers eat together on Wednesday night at Dr McConnachie’s house so I am off to go there now.