It's been a while

I have to admit, over these past few days I have DREADED writing this blog entry. So much time has gone by, and there is so much to say. I am going to have to be less detailed than in the past; I’ve even considered just bulleting things that I want to share. But with that, I must also apologize to mi familia for not writing sooner. I think I have at least a few valid excuses that should pardon my tardiness. Regrettably, I truly cannot remember much of the timeline of these past few weeks, so I will try to just mention the big points. More than ever I wish I had the time to journal, but between our internships and our schoolwork I have barely been able to stay awake long enough to turn out the light each night. This is the first night since I last posted that I have not been either buried in schoolwork, in a hospital, or off traveling somewhere.

So far starters, we all finally made the touristy trip up Table Mountain in the cable car about two weeks ago. We considered hiking it, but all of us are glad we didn’t as we would have frozen to death somewhere on the side of the mountain. Maybe we’ll hike in December right before we leave. Our trip to the top was abbreviated by the fierce winds and bitter cold that pretty much ordered us into the restaurant for hot chocolate, where we gathered the strength to face the winds for a few pictures before coming back down again.

Geez, I can already tell that this entry is going to be painfully scattered. I wanted to attempt to follow some sort of chronological order, but it just doesn’t seem right to wait to mention that we had an extremely ironic, though thankfully not as frightening, role reversal in terms of health status in these past few weeks. Almost two weeks ago, I went with Alison to the ER (which is called the “casualty” here) because she was in a tremendous amount of pain in her abdomen. This wasn’t new for her, but it was worse than it had ever been and we all feared appendicitis. It was extremely peculiar to be in this situation with Alison when about 16 months ago she was my caretaker in the hospital in Tanzania. Fortunately, I was not saddled with the same responsibilities or fears that Alison had to deal with when I had malaria. For starters, the hospital was more modern than my own hometown medical center. Not only were there no dirty needles on the floors, but there was toilet paper in the bathrooms and there were gloves in the cabinets – strikingly different from TZ. Aside from the comfort of being in an English-speaking hospital that felt just like home, I also had the benefit of knowing that Alison was going to be okay. She already felt much better by the time we saw a doctor, and in the end she was discharged without needing surgery. Basically, it was just a day in the lives of Alison and Jillian, two college students taking on the world, one healthcare system at a time.

But those of you who know the two of us should already know that the story does not end there. Persistent as Alison is, she decided that one tour of the Christian Barnaard Memorial Hospital was not enough. Just 6 days after her initial visit, during a follow-up appointment, it was deemed time for her appendix to say farewell to her other insides. Fortunately, this was on a Friday, and we had rented a car for the weekend and were able to use it to visit Alison in the hospital and bring her things she needed. I spent the night in the hospital with her, again more comfortable and peacefully than she had experienced with me in TZ. There were no violent hallucinations or painful injections; the only interruptions were when the nurses came in to help her to the bathroom and see if she needed anything. The quality of care and emphasis on patient satisfaction here mirrors the healthcare system of the US. The nurses were more than willing to answer our questions and explain things to us on demand. I actually spent much of the night there journaling about the peculiarity of our circumstances while Alison slept. But it seems awkward to include those thoughts now because I wrote so much on the comparisons between this hospital and the AICC hospital in Tanzania, and none of it is really relevant to the story now at all. In addition, it might be a little overwhelming to include a few pages on my views of the healthcare system and its inequalities when the rest of this entry is going to be so terse.

So I’ll keep with the trend and skip ahead to another topic. Alison was doing well on Saturday, and she pretty much demanded that we take the car we had rented and go somewhere. We went to Kirstenbosch, a beautiful botanical garden in Cape Town. It was a warm and sunny day and we all collapsed on the grass after a picnic for some long overdue sleep. Brendan and Kristen, I really wished you were there. This was a place you would have loved. Table Mountain was the backdrop, and the only directional marker for us in the vast gardens and forests. Apparently starting in November there are outdoor concerts held there on Thursdays that we are hoping to attend. It’s now Broken Social Scene over Thanksgiving break, but it’ll have to do. Dad, I think it might even beat the Deer Path Park shows. Maybe you should come check one out and see for yourself?

We finally tore ourselves up out of the grass and forced ourselves to leave in order to find a beach in time for sunset. I had given serious thought to hiding in the Enchanted Forest (yes, it is actually called that) while the garden closed so that I could stay there over night. But we forced ourselves on and eventually found a rocky beach where we could be alone with the sunset. Chris and I thought it wise to climb the largest rock in site (which wasn’t even that large, just slightly awkward and hard to grip). I ended up spending most of the hour fearing that the wind was going to blow me off and into the water. I wouldn’t even take any pictures of the sunset because I was too afraid to take my hands off the rock. Chris will be supplying me with his photographs that I would just pass off for mine if it weren’t for this admission. Family, you can probably hear my girly shrieks of excitement and fear on that rock if you just think back to any number of my clumsy or scary experiences (read: me stubbing my toe and running around the house singing/screaming, or, god forbid, molding mouthguards for soccer when I was just a young tot). Why do I shriek so much?

By the time the sun had set we wanted to head back to the house because Alison, against all odds, had gotten herself discharged from the hospital a day early. She was in slightly more pain now that she was off the IV pin killers, but she was looking good – not at all like she had just had surgery 24 hours earlier. With Alison recovering, we all used her as an excuse to stay in and crash on a Saturday night. The next morning we would be leaving at 5:30 am to go shark diving, so we really just went and picked up my friend Dan (who was coming with us) and went to bed.

Sunday was awesome. The ride to the bay was about two hours, and none of us were sure if this was going to be worth our money or, more urgently, our lost sleep. When we arrived at the headquarters I was nervous that our rate was going to increase due to several cancellations in our group. Alison’s surgery was an acceptable excuse, but we were still a few people short from our original booking. But I introduced myself to the manager as the person who made the reservation, and nothing was said about any rate changes. We all paid our bills with great relief and headed out towards the boat. For about the first half hour I doubted whether we were going to see any sharks at all. The crew insisted that we would, but I suspected that someone may have just made a pretty penny off of my touristy vulnerability. Just as suspicion and seasickness were starting to get the better of me, I heard a call from the back of the boat that we had our first shark. From there on out we were the hot spot of the ocean. When one shark left, another quickly found us. We even got to hang out with a HUGE southern right whale that was just a few feet from our boat. As for the actual cage diving, we were a bit unfortunate because the water visibility was only about 2 feet. Some of the divers did see sharks under water that were two feet away from them, but when I was diving I only saw them with my head above water, when they were probably three and four feet away from me. What was scary was that the water was so rough that it was all but impossible to keep your extremities inside the cage. I found it funny that the crew emphasizes the importance of keeping your limbs inside at all times, but they use a cage with gaps so large that your entire leg can float out. I was given the front of the cage as well, so I was faced with three sides, rather than two, from which the shark could chomp at my toes. It became a game to see what positions were best for keeping yourself inside, but really none of it was too scary because the sharks were far more interested in tearing into the fish bait than they were the human bait. Apparently, we don’t taste very good.

Shark diving ran a bit late, which was out of our control, and we didn’t return until about 6:15. Dr. Bender had scheduled for us to view a film for class at 5, even after we had all told her our plans and stressed that we did not know if we could be back in time. To make a long story short, she was more than a little ticked off. She took it as disrespectful to herself and the program, even though weekends are our only time to travel and escape the stresses of the week. She, on the other hand, teaches a course once a week and has the rest of the week to go off gallivanting through Cape Town. Even when Alison was in the hospital she decided to take off for Stellenbosch. Furthermore, she is not even conducting any research for the University while here. But anyway, I don’t even want to go into all the nasty details, because Sunday through today have pretty much had everyone on overdrive with stress and rage. Dr. Bender sent us an email telling us she was disappointed with our work, and we tried to invite her over to talk to us about her expectations, and consequently give us an opportunity to air our grievances. For example, the assignment of writing a four-page paper on a conversation with a character from the film viewings is intellectually insulting to juniors and seniors in college. We have enough work here that we do not need such childish assignments, and we all feel that we are being chained to this house to do work so that we cannot take any risks by going into Cape Town. Dr. Bender has said on numerous occasions that it is not safe to go out, so I don’t even understand why she has come here. If we are never going to leave the house, and if we are going to waste our time writing movie papers when we should be investing in our research papers, we are all going to leave here feeling regretful of coming in the first place.

The week dragged on, everyone bogged down in papers and projects, until last night, when I pretty much castrated my reputation with Dr. Bender in the name of our dignity and our time. Bendie, as we have endearingly taken to calling her, was over our house to have one-on-one talks about our research papers. I respectfully asked her if I could speak with her for a few minutes about mine since my job description had just changed yet again the day before and my topic again had to be scraped. She said no, and said that it was getting late. I then asked if she had received the email the class wrote asking to discuss some issues related to the course and asked if we could discuss them perhaps the next day. Again, she said no, because she wanted to go to a wine tasting after class. I finally just put myself on the chopping block and said that we needed to discuss the movie assignment because we felt it would be far more beneficial to have a discussion. She didn’t take that very well. Her response was,” So what, you just don’t want to write it? Is that it?” Wanting to be honest, I told her that we felt so stressed about time already and we felt this would only take away from our time for more important assignments. After a few more snippy comments and a lot of stern body language she said “fine, you can tell everyone they don’t have to do it; I can’t.” So that was that. Now Bendi hates me, but at least I am able to sit here and write this entry instead of writing yet another pointless paper.

I am getting pretty tired now though and I’m not sure I can keep going much longer. I think I’m gonna cash in and just finish this post after class tomorrow.

10.5.07

I’m baaaaaaaaaaaaaack. Class just got out and we unfortunately had to cancel our plans to take off for Stellenbosch this weekend because the car we had rented was in an accident. So now I have time to stay on campus for a while and catch up on emails.

Jimes, I am talking to you right now, and I wish I could just curl up in moso 206 with you for a lazy afternoon. I finished the Audacity of Hope, so we could finally discuss it together and maybe even have another discussion about transsexuals for old time’s sake. Ahhhhh, I miss you!

I guess I should try and write a little bit about my internship since a few of you have asked and I have yet to really mention it. For the past few weeks I have been bouncing around the DTHF, trying to find my place. I don’t even know if in my last post I mentioned working with an American Doctor from Puke, I mean Duke. I’m too lazy to go back and read through what I wrote so I’ll just repeat myself even if I already mentioned him. This Doctor is here doing research for his PhD on HIV and TB co-infection. He conducts his work in Gugletu, a township outside Cape Town with one of the highest incidence rates of TB in the Western Cape. I was at first going to just kind of shadow him and help with his data collection, but this week the executive director called me into her office to tell me that she did not think he needed my help and that I could be more useful in this pregnancy study that is also taking place at the ARV clinic in Gugs, as it is commonly called. I haven’t been given all of the specifics yet, but it looks like the foundation is collecting the data in collaboration with the Dept. of Public Health to do a study on the effectiveness of triple-therapy in pregnant woman. I think they are also looking at adherence rates and the status of the children, but again, the details have yet to be disclosed to me. Right now I am just pairing up with one of the counselors there to tear through a room full of files and track down all the women who have been patients at the clinic. I’ve been finding the numbers, and Nokwayiyo has been making the calls to set up interviews. There are pages and pages of names, so it may be some time before we can get to everyone. But if all goes well, I will be helping with the interviews and the compilation of data that will be used to publishing. Therefore, my name would get to be published on the study alongside all the doctors and PhD’s. I wouldn’t hate that.

As for my actual experience at the clinic, it has only solidified my uncertainty about my career plans. It has been exactly the experience I could have hoped for, and in that sense, exactly the experience that makes me question whether or not I want to go to law school. For my first few days at the Hannan Crusade Clinic, I was working with Dr. Dave, sitting in on his examinations and meeting with patients. His study takes people who have tested positive for HIV but have not yet started ART and are willing to donate their time for some further testing. He screens them for TB with an x-ray, sputum sample, blood test and urine sample. More often than I’d like to admit, the patients do turn out to have TB. They are then are started on 6 months of TB treatment, and for the first five months they given that exclusively. After 5 months, ART is introduced. This is because if you start them at the same time, the combination can be toxic and sometimes even lethal. One needs to either be on ARVs for a long period of time before beginning TB therapy, or he/she needs to start TB treatment before taking ARVs. Dave is trying to discover benefits of waiting five months to start ART in order to determine the most appropriate time to introduce the anti-retrovirals.

Working with Dave has given me a lot of exposure to medicine, and in some ways, has made me wish I had the stomach for it. One patient has extra-pulmonary TB in his lymph nodes, so it sort of looks like he has ping pong balls on either side of his neck. A tissue sample had to be collected for testing, which involved probing his neck with an uncomfortably thick needle until they had collected enough gunk for the lab. Watching that reminded me of why I couldn’t be a doctor.

What has been most interesting for me in working with Dave is the interview part of the examinations. The tough questions, like the ones about safe sex and partner disclosure, always illicit questionable answers. One of the men we interviewed said that he has not been sexually active since he was diagnosed a year ago, but that he has two girlfriends with whom he now uses condoms. It’s hard in such a brief time to earn the trust of patients who fear our judgment. And that’s the exact area that I feel the Doctors often skip over for the sake of time. They don’t have time to build rapport with their patients before jumping into intimate issues. It’s too bad, because I feel they are losing ground in effective counseling because of this haste. But I’ll get to that later. There are some really amazing HIV counselors at this clinic for whom I am quickly erecting pedestals. I could write an entire entry on them; maybe sometime soon I will. But back to the interviews, I have been fascinated not only by the answers to the personal questions, but also by the cultural context in which these patients are ill. One man says he has night sweats and coughs blood, but he actually has a job (unlike most in thie community) so he can’t just take off work to see a doctor. Another man lifted his shirt for examination to reveal a scar from his breastbone to his bellybutton. It was a stab wound from years ago, back when black/white relations in Guguletu were far from peaceful. I didn’t even know how to respond when he started to explain that one….

I hope that I can come back to writing about my job because there is just so much I want to say. But I’d really like to get off campus and GET FOOD right about now. Everyone else is leaving and I don't want to take the bus back alone. So maybe tonight I’ll write more about work. Wednesday was pediatric day at the clinic, so you can imagine how much I’d have to say about that. The kids owned me all day and I got very little work done. For now, I must say goodbye. I am sorry that this was such an awful post. I gotta step it up.

Promise to write again soon…