19 October 2007
We are in Mbotyi on the Indian Ocean. Caroline has been so good to us by making the arrangements for places to visit that are located near some beautiful locations in SA which allows us to get away on weekends when the medical system in Mthatha seems to essentially shut down. As volunteer doctors we generally aren’t expected to provide after hours care so our weekends are free. The environment we work in is so different than what we normally experience at home. It is difficult to explain the stress of working in a place with an unfamiliar language and culture, where the patients are so disadvantaged, resources are limited and we try to work within locally accepted practices while providing the level of care we consider acceptable. Going away on the weekends offers the chance to take a break from this intensity. Visiting areas within reasonable driving distance has offered some additional and unexpected insights. I have seen some of what are called peripheral hospitals. I am amazed at the distance they transport patients in labor and even more at the terrible roads they must use. When people we meet find out why we are here, we often get thanks for coming and occasionally questions about why we went Mthatha rather than their small communities where they see a much greater need. It helps to just get out of medicine and be a tourist for a day or two each week and see what people’s lives are like. It’s amazing at how inexpensive it is to eat and travel in the Eastern Cape. It feels like such a bargain and yet we know that in part, it reflects the level of poverty in the area.

Mboyti River resort is an interesting place. It is remote in that it is rather difficult to get here because of the bad roads. The hotel functions like what I imagine was done in 5 star hotels in the 1920s….without the dress code. The service is fantastic but the facilities are old and simple. The staff seems so sincere about a making sure you are happy with your experience. Tomorrow we will be off to see some of the local sights. After last week’s adventure, I am agreeable to going on hikes with a group rather than by myself. It looks like a lovely day. The ocean is quite loud but will be great for sleeping.

Earlier today at the hospital, we started with Grand Rounds which was about Ophthalmic Problems in HIV patients. It was very interesting. We had our normal morning report and find that we have an ongoing and perhaps worsening problem with lack of linens preventing surgical cases from being done. The residents even tried to do surgery with sterile drapes wrapped around them because there aren’t any gowns at the moment. It is difficult for me to comprehend this. I did the teaching ward rounds again so Dr Buga could go to the CEO to solve this problem. The residents and I are really getting along well now. It’s a nice feeling but sad it took until now.

Before leaving this afternoon, we went to Itipini where Ed and Scott saw a few orthopedic patients. Caroline and I had a tour of Itipini. I am told Itipini means “on a dump” in Xhosa (the local language). It is a village literally built on a dump with the materials they found in the dump. You will see photos but I don’t think I can communicate what this place is like. The people here have no where else to go. They take what they find in the dump and make shelters, their homes. The houses (I have trouble using that word) are usually about 8x10ft and made of metal pieces. I can’t tell what holds them together but I’m sure it’s whatever fastening material they find. The metal is corrugated metal pieces left over from construction, barrels opened and flattened, old car parts (hoods, roofs etc). The roofs are often held on by rocks set on top. The floors are dirt. There isn’t running water or electricity except in the community center. They have a central water faucet where people can fill their water jugs to take home. There are paths between the houses that randomly sprang up as more houses were built. There are pieces of glass and other debris all over the paths that make me nervous for the children walking around but realistically it’s the least of their problems. Our connection at Itipini is Jenny McConnachie. She has worked here for years. Through her efforts, they have built a series of small building for schoolrooms and other community activities and a medical clinic where they provide basic primary care. The facilities are very basic. They have single faucet to provide clean water for the 2000+ people estimated to live there. The people are involved in helping to provide the services. I can’t say I understand how the people live here our how the community functions but I have never experienced this degree of poverty before. It was a profound, uncomfortable experience. The people were generally happy to see us. They usually like to have their picture taken if we will show it to them on the camera. Some of the kids ask to have their picture taken just to see it. We all noticed the lack of a single request for money by anybody there which is notably different from our experiences elsewhere in poor areas in South Africa. It was a sobering experience as we left Mhatha for the weekend.

20 October 2007
We had a great day here in Mboyti. There’s something relaxing about hearing the ocean all night and waking up to the sunrise coming over the ocean horizon. The meals here are served in their dining room and are included in the daily room rate. It would be impractical to have it any other way because of the remote location. After breakfast we went on a driving and walking tour with a local guide. He took us to 3 gorgeous waterfalls and a tea factory.

The waterfalls were truly beautiful. We enjoyed them all and have great pictures. The area is covered with tea plantations. We are told there are only 2 areas in South Africa that are suitable to grow tea. The tea factory is a locally owned cooperative. It was quite interesting to see how the tea is processed and packaged for shipping to tea manufacturers. We also happened to see some really interesting examples of daily living here. We saw people washing their clothes in the river and hanging them on fences and bushes to dry. Kids were swimming in the river just above the waterfalls. Boys were herding their goats and cattle with these shepherds on foot or horseback. Craig was our guide and doing local guided tours is only job. He would arrange any activity we wanted. He is looking forward to the start of high season and increased business. He was a great guide and took us places where it felt like we were seeing how people here really live as well as taking us to places I am sure we would not have found on our own. It was a very good morning. It is usually difficult to see what a place is really like beyond the tourist sites and hotel grounds. There isn’t much here beyond the beach and scenery but they are magnificent.

We returned for lunch and then I had planned to go to the beach. I didn’t last long. It was so windy that I couldn’t stand the sand blowing in my face. I took some photos and had to come back to the resort. Caroline had a horseback riding tour with a guide arranged by Craig. It was too windy for Scott to go fly fishing in the Mboyti River so they postponed that to try in the morning.

After dinner, the big even tonight is watching South Africa compete with England for the World Cup in Rugby. Hopefully tomorrow morning will be more comfortable to spend some time on the beach before we head back to Mthatha.

21 October 2007
By luck, I woke up just before sunrise and had an east facing room with a little balcony overlooking the beach. I took some sunrise pictures. I was glad to see my camera working well. Last night I had trouble because sand had blown into the camera during the short time I was on the beach yesterday afternoon. The tea dust in the factory may have also contributed. I had to really clean it out to get the lens to go in and out and the shutter to close as it should. I think it’s OK now. I doubt I will find a camera store in Mthatha that could do anything for me this week, so I am hopeful it continues to work well. I also have to try to find an extra battery this week since I lost one with the camera bag that was stolen.

It was still very windy so after only a brief walk to the beach (without a camera this time!) I stayed up at the resort for the morning until we checked out. Everyone was pretty happy after South Africa beat England for the Rugby World Cup last night; everyone that is except probably Megan. As a consolation, she will be happy that her Manchester football (soccer) team won. She was in Durban this weekend and returns Monday afternoon.

After lunch we headed home. We took a few minutes to drive through Port St Johns which is where the Mzimvubu River enters the Indian Ocean. The view of the beach was beautiful but there wasn’t much more to see so we headed back. After a beautiful weekend the rain started on the way back. We felt lucky for the timing. It has been pouring ever since. I’m just thankful we haven’t lost power yet.

22 October 2007
It rained hard all night and stopped early this morning. It was a sunny day but another storm moved in tonight, although not nearly as intense. The weather here seems to follow this pattern of being quite intense and moving through quickly. The rainy season is starting but at least it is starting to warm up. It is definitely spring here. The trees are starting to bloom now. The colors are different as well as the trees themselves but really beautiful.

I have noticed how many people are on the road walking….and hitchhiking. Walking is a very normal method of getting around, so unlike in the US. Some of this is probably economic but much of it is cultural. There are many cars here of course, but there are always people walking and not only in town. In fact the roads outside of the city seem busier with the walkers than in town.

Each morning as we drive into town, the road we take is teeming with students going to school. The schools all seem to require uniforms and the children look fabulous. It’s such a contrast to seeing them at any other time. I know there is some help for families who can’t afford the clothes and somehow all the kids get their uniforms.

There seems to be a very diverse pattern of dress for women. Women can wear very traditional styles and others wear very modern clothes. The traditional attire usually includes a headscarf and a dress with a coordinated apron. Some add a blanket wrapped around them. When we were in Lesotho, they said the blanket was a sign of respect to their king. When I asked about the use of the blanket here, they told me it doesn’t have a meaning. I guess what strikes me the most is the lack of uniformity and the acceptance of all the styles. Men have less diversity in their dress styles in Mthatha. They seem to wear western style clothing of pants and t-shirts. Professional men wear suit coats. There seems to be very few who wear anything I could call traditional.

There is a system of how one refers to other women and I am trying to learn the nuances. Nurses are called sisters. Nuns are also called sisters. If you are talking to someone of near to your own age, she is also sister. If you address a woman older than you, you may call her mama. This one seems to correlate to addressing someone as Ma’am. These terms have meaning and are used as a sign of respect. The men use less slang to refer to each other. I never hear the brother or bro terms. I do hear ‘hey man’ or ‘man’ occasionally when young men address each other. ‘Man’ is pronounced like mahn. I have heard that more on radio than in conversation on the street.

We had a typical clinic day. Our beds are more than full in preparation for our main surgery day tomorrow. I am doing more ultrasounds each week but it is very difficult with the equipment available. We are going to try to do the colposcopy clinic again this week. (I’ll be bringing my own bottle of vinegar!!!) It’s hard for me to believe that I am getting to the end of my time here. I know that if I were able to be here a few more weeks, I could accomplish much more. It takes this long to know the system enough to operate somewhat independently. Megan asked me last night if I would come back. I can’t answer that question now. I think I will feel differently about it in a few months. I told her I could only come if I could live with her again. It seems to have been a great match for both of us which I find odd considering our age difference.