13 October 2007
It has been a busy couple of days. Tonight I am in the Sani Pass Hotel. We started our drive from Mthatha early in the afternoon Friday. The day couldn’t have been more beautiful. It was one of the nicest days I’ve seen here. It was sunny and the temperatures were up to the high 70s. We went through the outskirts of Mthatha and houses spaced out and the landscape became rural. When we left the Eastern Cape province we entered the province of KwaZulu-Natal. As you might expect, this is the home of the Zulus. The Zulu language is similar to the Xhosa spoken in much of the Eastern Cape, but with fewer clicks in it. There was a larger town of Kokstad to pass through as we turned off the large highway. As we stopped for gas, it looked rather familiar as a rest stop on the highway. Besides the gas station there was a fast food restaurant (Wimpy’s) and a gift shop but with a nicer selection than I would expect. As we drove closer to the Drakensberg Mountains, I noticed more European style buildings. There were many more signs of the European settlers who had settled here but mixed in with African culture as well. As we approached the towns of Underberg and Himeville just before reaching Drakensberg Park, it appeared that these are much wealthier communities. Entering the Drakensbergs, the roads became much rougher. We reached the hotel about dinner time and found the usual fenced site with guarded gates. After registering, we checked in to our rooms which are in a building with a thatched roof. The inside was a fairly typical hotel room. We each have a little patio that looks out over the grounds, which are beautiful. There is a pool but it is definitely still too cold for swimming. Meals are all included so we went to dinner at 7pm. It is basic but nice food. After dinner there was a group of about 20 young Africans that sang a cappella. Their repertoire included a variety of Christian and African music. They are a group that is trying to speak to young Africans about preventing HIV and decreasing violence which is also a major problem here. They asked for donations after their program. They ended their program with 2 traditional Zulu dances. It was very interesting and a delightful surprise.

Today started with a walk following one of the walking paths the hotel has laid out. This one goes to the waterfall nearest the hotel. It was beautiful and we could get very close. The view with the early morning light was spectacular. We returned to the hotel for breakfast. After breakfast we got into our 4 wheel drive vehicle with our guide to take us up the Drakensbergs to Sani Pass. This is the only way to enter the kingdom of Lesotho from the east. This mountain range was thought to be the highest in southern Africa until a few years ago when it was demoted to 2nd place. The vehicle has obviously been on many rough roads before. The driver, Martin, brought his father along and besides Caroline, Ed and I there was a young couple from Paris. Caroline and I were packed into the back seat. Finding 2 pillows to sit on in the back seat should tell you about the condition of the seat and the condition of the roads. I’m pretty sure the middle seat was not much better. Ed had a little more room for his legs there and shared the middle row with the French couple. The trip was well worth the ride. The road went from winding to hairpin turns with the surface getting rougher as we went. There were waterfalls, one after another. The views were spectacular. I was glad to be in a small 4 wheel drive vehicle with an experienced driver rather than one of the tour buses. I don’t think there are frequent accidents but those buses just look like they could tip over more easily.

Once we reached the South African border we went into what is called no man’s land where no one claims responsibility for maintaining the road, such as it is. It got steeper and rougher and more beautiful at every turn. At the top we went through Lesotho customs and then the guide took us a few km further to a small Lesotho village. The people support themselves with herding but have little else. They say farming has never been successful here. We were taken into one of the rondovals whose owner was there with goods to sell. As a signal to the guides, they put a white flag (a white plastic bag) on a pole outside the house if they have goods for sale. The guides had a short program describing the Lesotho people’s lifestyle and customs which was interesting. They made a big point of telling us that the woman depended on tourism for her income. She made the traditional hat from Lesotho and these hats are supposed to emulate a specific mountain. She also had a homemade beer that smelled very much of yeast. She had bread cooking in an iron pot in the coals in the middle of her rondoval. The glowing embers of the fire surrounded it. The fuel ‘bricks’ are made of dried cow dung, the only fuel they can afford. There was a solar panel outside the door which created enough electricity to power their radio. The people wear a blanket around them and this is said to be a sign of respect for their king. The guide said Lesotho is the 3rd poorest country in the world. South Africa pays several million a year for water coming out of Lesotho and this income allows the kingdom to provide free medical care and education for the entire population. They must pay only for transportation to the services. The children generally live at boarding schools since they are at distances too great to travel daily. The boys are brought into the hills by an adult male at around age 13 and taught what they need to know to survive. They come back to the village and undergo a public circumcision after which they are considered a man. They are give a stick made of ironwood and decorated with a pattern specific to their family. The stick is very important for their identity as an adult male in their family, is used as a weapon and is carried with them at all times. When asked about female circumcision, the guide said that it was done to some degree but it is done very quietly and often at night but not a publicly acknowledged ceremony as for the boys. He was clearly uncomfortable answering the question. The guide seemed to have a lot of scripted answers and I suspect some of what he told us is exaggerated or untrue but makes for a good story. The whole point being to get us to purchase goods or simply give her some money of which some percentage goes to the guide as well. We all bought some bread for R5, about 75cents and some of her other goods were also purchased.

Next we headed back to the border where there is a pub said to be he highest in the world. We had lunch and then headed back down the mountains. It began to rain but this cleared as we got back to lower elevations. They returned us to the hotel in one piece with fantastic photos. After dinner we looked at some of the pictures and now I will head to bed.


14 October 2007
It was another adventure in Africa today. Early this morning I woke up and spent some of the early morning hours bird watching. I will have to get a book on local birds so I can identify some of these by name.

After breakfast we each went to a separate activity. Caroline was able to sign up for a horseback riding tour of the area for a couple of hours. She said it went well considering an unfamiliar horse, tack and terrain. Ed went golfing. I went on a hike.

The hotel has 4 marked trails. We had been on the trail to the waterfall yesterday morning. In the afternoon I had gone on portions of the other 2 as well. Today I went on the ‘3 hour’ trail up the mountain to a plateau said to have incredible views both north and south. It isn’t an organized or guided event. The trails are marked with stones painted by color to guide you. As it happens, a South African family was starting out at the same time on the same trail. It didn’t take long for the grandparents to drop out. Then one of the children turned back. The mother and one boy, about 10 years old, continued with me. It was a very steep climb and was much longer than we were led to believe. They eventually turned back also. I had checked at the desk before leaving and having been told this was well marked and safe to do alone, I continued. I did reach the plateau and was rewarded with an incredible view. To the north I could see the road we took yesterday to the Sani Pass. The mountains were gorgeous and Hodgson’s Twin Peaks stood out making the Giant’s cup you can read about. Across the plateau to the south, the valley was as beautiful. I could see Himeville, one of the towns we would eventually drive through on our way back, as well as 2 lakes and a dam. All in all, well worth the steep climb.

I started across the plateau to the north to reach another trail which was to take me back to the hotel. Unfortunately, I never found it. I had the written description that told me the trail would be following a seasonal stream. I thought I could see the trail by a creek bed and headed for that. I found my way down but it wasn’t because there was a trail to follow. Because the road and the hotel were constantly in sight, I just worked my way down using them to guide me. It took a little longer than planned and I got pretty hot and tired. I managed to twist my ankle a little but had no other problems. Fortunately I have considerable experience in management of ankle sprain thanks to my children! I also had the luxury of having my own orthopedist waiting for me and have been certified as having a mild ankle sprain….nothing more. Once I got back I was able to get a quick shower and we headed out. When we reached Underberg, we stopped at a gallery and studio for which we had seen an interesting advertisement. It was wonderful. It is run by a couple that does photography and pottery and they have a few rooms where they show their own work as well as other local artists. Had I been more confident that I could safely transport this beautiful and fragile work home, I am sure I would have purchased more.

Then we stopped for lunch at a small restaurant and gift shop (of course) just down the road, at the recommendation of the gallery owner. It was called Ducks and Doolittles. It also had a petting zoo. Many of the small creatures roam freely and occasionally must be shooed out of the open dining room doors. It no longer surprises me to find no locally produced items in these gift shops. They have things from India, China and other Far East countries. This is a highly rated tourist and vacation area and they seemed to stock the traditional junk souvenirs.

Then we were back on the road to Mthatha again. This is the longest weekend trip we will take. The weeks are filled with the hospital work but these places do truly shut down except for emergencies at noon on Friday. Generally, only the resident staff and students go in on weekends. There is little to do in Mthatha so this gives us the opportunity to do some weekend sight seeing. We will go to the Indian Ocean next weekend.

It’s sad to see the landscape change as we entered the Eastern Cape province again. It’s not the terrain; it’s the housing in terrible condition and the garbage strewn along the roadside. The farm animals are allowed to roam and create traffic hazards. It is known as one of the places to avoid because it is so poor and unattractive. The gallery owner commented on this, saying she was sorry we had to have our experience based out of Mthatha although she recognized the needs there. We discussed why it would come to be that a community would allow their roadways to be so littered with garbage and so many buildings to deteriorate. She described it as a combination of poverty as well as a poverty of spirit. That seems to describe it to well to me. I often get the feeling of despair of hope for anything to improve in their lives or their community.

We had a brief discussion of how difficult it is for any of us to do the volunteer work needed in our own communities. When a Canadian couple started a project for the poor and HIV affected children in her relatively well off community, she and her husband began to volunteer there also. It seemed to her that it took the perspective of coming from somewhere else to recognize the need to act and be willing to do it. The culture and politics are so complex here. I think I will only have a limited understanding from this month. I have had conversations about politics with many of the doctors from other African countries. I find their perspectives interesting and educational. I believe I need to hear the stories from many perspectives because if I think about how our politics and government would be described by a single individual how inaccurate that might be. It would be different from a Democrat, Republican or Libertarian viewpoint or from a rural or inner city or suburban viewpoint and so on. So, many stories probably make a more complete picture. I keep listening and learning.

15 October 2007
Monday morning and we’re back to work. We reviewed the 22 C-sections done in the last 3 days. One patient returned this weekend after being sent out on ‘home leave’. She had been admitted earlier last week after PROM but when she didn’t labor and there was no sign of infection, she was sent home to wait as there were no elective surgeries being done for lack of linen. She had a healthy baby.

They are noticing a new group of problems in their HIV patients; at least it seems this is the link between them. They are developing hemolysis and thrombocytopenia and renal failure. Only the one I described last week died. The others are on dialysis. It seems to be a manifestation of HIV. They are putting together a case list to study.

Today was our firm’s clinic day. The patients start coming at 0700 but we don’t start until after 10. It is a long day for patients and staff and no one stops for lunch. The patients can go to a small canteen where they can buy snacks or they can buy fresh fruit and bread from women who walk through the clinic and hospital waiting areas with a box of this food balanced on their head. When someone wishes to buy, they quite easily set the box down, squat beside it and complete the sale. She seems to lift the box back onto her head with little effort. The clinic fills up quickly in the morning and then slowly dwindles as the afternoon progresses. I was able to do more in clinic today as they assigned one of the nurses to interpret for me. The first one seemed rather annoyed with this task. The second was delightful. I thought she was so helpful but around 3 or4 she told me all the patients had been seen. After that I saw about 6 more people with Dr Mdaka. It appears that she was ready to be done for the day and so she just told me we were done! She was still pleasant to work with and I will simply need to ask about the people still in the waiting room and not take the answer at face value.

Tomorrow is our main surgery day. The schedule is always full and the hospital beds will get filled tomorrow.