July 24, 2009

I got to Hammanskraal this morning and gave the lecture on Pertinent Facts to Know about HART in 2009.  Just as I got started there were ambulances galore with a lot of people brought to Casualty from a bad accident in which 10 people were killed.  So all the surgeons had to leave but all the other disciplines remained: pediatrics, medicine, HIV, OB-gyn and psychiatry.  Some of the surgeons returned when I was almost half through the lecture.

Then I got on the road and about 50 kilometers up the road we came to a dead standstill.  It was where all those people were killed in the accident I mentioned above.  A big rig lost control on the toll road NO and crossed the median into oncoming traffic.  We were delayed for probably 35 minutes before the traffic began moving.  I drove 6 hours to get to The Kruger National Park…actually, Sefapane Lodge and Safaris.  This is a very nice place, the thatched lodge I have is very nice and comfortable.  It has air-conditioning which I don’t need! There is a small kitchenette with a small refrigerator and a tea/coffee pot. There is a king sized bed with mosquito netting domed over it.  The bathroom is very nice with all the necessary accoutrements.  Right now I am sipping a cup of tea!

They immediately put me into tonight’s safari and what a jewel this one was!!  First of all it was very COLD, tears were streaming from my right eye until after sun down when the wind died down…truth of the matter is, I asked God to dry up my tears so I could see!  What happened? The wind died down and I could see!  We saw lots of impala, then we saw two male kudu grazing and moving through the underbrush slowly.  Next we came across two magnificent male buffalos and we watched them for a while.  We had spot lights to pierce the darkness and whenever we saw eyes, we would move in closer for a good look.

Then we came into a clearing where there were numerous lanterns on two long tables set with fine dinnerware and cloth napkins!!!  We were served a gourmet meal in the bush!  We were served delicious lamb chops with chutney, chicken kabobs.  There was tossed salad with balsamic vinaigrette dressing and a pasta salad.  There were baked potatoes and the traditional South African dish of pap with chopped tomato sauce.  Dessert was a brownie with whipped cream which I refused.  I had two glasses of a very good South African red wine, a syrah.  There was a bar set up in this clearing in the bush with the finest alcohol of all kinds as well as Coca-Cola drinks, juices and bottled water. How wonderful can it get in the wilds of the great South African outdoors?  In the middle of all this was a roaring bonfire and we had staff with rifles at the ready in case of danger lurking in the darkness.  But the best was yet to come!!!  As we drove away from the camp, we came across two lionesses with four cubs just 12 – 15 feet off the road.  They seemed very contented and were grooming themselves; the cubs appeared to be asleep.  I was in charge of the spot light so I didn’t get any pictures, but the lady in the seat just in front of me had a very nice camera that took wonderful photos.  She said I could download them tomorrow and if the memory card didn’t fit, she would make a CD and send them to me.  Her family, a husband and two children are here on vacation from Holland…the daughter’s birthday is tomorrow!  I was the only American; there was another older husband, wife and son family from Holland as well.  Then there were 14 Italians (two truckloads all total).

Tomorrow is an all day safari; I get up at 5:00 am to leave for the bush at 5:45 in the morning.  Thank God for Tania getting me some of Anton’s warm things to wear: muffler, sweater, snug head gear, sheepskin-lined coat and gloves.

What a day!!!I thank God for this wonderful change in my activities here in South Africa!  I see so much death and dying that this bit of peaceful outdoors in the wild is doing me a world of good!

July 25, 2009

While on safari this morning, my wallet disappeared and I have no idea how.  I am sure I had my hip pocket picked by someone that knows how to do it very well.  We scoured the area and our guide called the Sefapane registration desk to have housekeeping check to see if I left it in the room…(negative).  We were having breakfast in the bush when I first felt that my hip pocket felt empty.  I only had perhaps <100 Rand in it.  But my Amex and MC, along with all my licenses are gone…and my Starbucks card!  Fortunately, I do have my Passport.  But now I have no driver’s license to drive the 5 1/2 hours back to Pretoria. I don’t have a phone that I can use to call anyone.

The safari was wonderful.  We saw plenty of elephants, hippos, an ostrich, a pack of hyenas nursing their young, many hundreds of impala, some herds of kudu and water buck.  We came upon a large family of baboons and monkeys.  There were crocodiles galore along the rivers.  Mid-morning we came to a clearing that was well equipped with electricity, restrooms, gasoline…it really was a tourist stop!  That is where the guide fixed breakfast for us and also when I noticed my hip pocket was flat!  Then we resumed the safari into the bush.  We saw a jackal and many giraffes.  At about 2:00 pm we stopped, this time in the bush for lunch.

July 26, 2009

This evening I went to a private game reserve owned and managed by a husband, wife and three sons, the eldest being 25 years old.  When we arrived there was a beautiful water buck with huge horns calmly feeding on hay they had put out for the wild animals.  Beside him there was a magnificent male wart hog doing the same.  Margaret, the lady of the house had fixed a wonderful traditional dinner for us consisting of pap, potatoes au gratin and a baked potato, chicken skewers on the grill, boerswors (traditional South African bratwurst) and a lovely tossed salad.  Then we went into the veld and looked at the southern hemisphere night sky.  What an experience!  Our guide was very knowledgeable about the subject.  For the first time in my life, I saw the Southern Cross!  Brandon, our guide, taught us how   to tell time, almost to the minute by looking at the Southern Cross.  The Southern Cross turns clockwise two hours every fortnight.  I saw the Scorpion for the first time from head to heart to stinger and tail.  We looked at Saturn with its rings and Titus one of its moons, and then came Jupiter and our moon.  Lastly we looked at a cluster of new stars, only about 2.5 billion years old and then a cluster of old, dying stars.  Then back to the farm house for dessert of a brandy torte with vanilla ice cream.  Margaret gave me a signed recipe that I’ll have to try when I get home.  That was the way to end a mostly great weekend!

July 27, 2009

Today was the long drive back to Pretoria (without my license) and I didn’t get pulled over!  Not much else happened and I am off to bed early.  I have to be ready for the onslaught of deathly sick people tomorrow!   

July 28, 2009

Today was mostly filled with taking care of wallet matters; police report, cancelling credit cards et cetera.  Then I took a well deserved afternoon nap.  Around 5:00 pm I started ambling about the Sefapane grounds, went to the lounge for a glass of wine, but too early; not open.  Then I saw a flyer about an astronomy evening this evening.  I registered and off we went.  This was 12 km from Sefapane out into the bush, not Kruger, to a private game reserve owned and managed by a husband, wife and three sons (actually only the eldest).  It included dinner and a look at the night sky in the southern hemisphere.  What a treat!  Our guide was a young Africaan named Brandon whose profession is nature preservationist and bird keepers.  As part of his training, he was taught astronomy.  I was totally impressed with his knowledge of the night sky!  I saw the Southern Cross for the first time in my life…but of course, it can only be seen in the southern hemisphere!  He pointed out Scorpio from its head to the heart, the stinger and the tail.  Out here in the bush the stars are amazingly bright and you can see so much more than we can in Atlanta.  There was the South African staple of pap and boerewors (a favorite sausage), chicken kabobs on the grill, baked potato, potatoes au gratin and a tossed salad. Then there was the night sky and all of the new things I learned about the Southern Cross.  Brandon taught us how to tell time by the Southern Cross.  We looked at the moon through the telescope, Saturn and its rings and Titus, one its moons. We saw Jupiter up close. Then we looked at a cluster of young stars only about 2.5 billion years old and lastly, a cluster of old dying stars.  Then we headed back for dessert which was a homemade bourbon torte with vanilla ice cream!  Oh so delicious!  The lady of the house gave me the recipe to take home.  I’ll have to make it when I get back.

July 28, 2009

I had a busy day at Jubilee.   We saw close to 170 today…so many children who were born with HIV and the parents neglected to bring them back for follow-up even when the mother was told the child had HIV at birth.  They wait until the child begins to “fail to thrive” before bringing them back to the doctor.  I bet we saw at least 50 such cases today.  We initiated ARVs in approximately 15 patients that had completed adherence counseling satisfactorily.  One young man that we saw last week with 840,000 RNA copies per ml returned today after more adherence counseling.  When we saw him last week, his lower lip was twice the size it should have been and blistered unbelievably.  I suggested they start him on acyclovir for his herpetic lips.  Today his lips are dramatically improved.  I think our discussion with him about his not taking the medications sunk in.  I told him last week that if he didn’t start taking the meds, his ancestors were definitely calling him.  Today we started him on an accelerated regimen consisting on 3TC, ATC, TDF and Kaletra.  This regimen should rapidly bring his viral load down and hopefully bring his CD4 cells up which were in the single digits. 

Then there was the lady with a husband who has promised to be tested but failed to do the test.  He has a tiny baby girl who was born with HIV 3 months old.  The mother states she took nevirapine and AZT for six months before delivery but there is something drastically amiss here because that combination usually does not fail to protect the child being born!  My suspicion is that the husband would not allow her to take the medication.

July 29, 2009

Wednesday, hump day!  I was supposed to go to Mathibestad today, however Jacob Lesotho got delayed.  He was supposed to take me one last time since it is so far out into the tribal area.  So I worked at Jubilee until close to 11:00 am.  Before I left, we saw close to 90 people at the Wellness Clinic!  Jacob showed up and we went to Mathibestad where I remained until 3:00 pm.  At Mathibestad 70 people were seen today.  There was the widower who had a CD4 count of 17!  His wife died four

years ago.  So I asked him if he has a girlfriend.  He said, “Sure”.  So then I asked him if he uses condoms.  His immediate answer was “No!! I don’t use condoms”.  He quickly changed his story to “ever since I found out I have HIV, I have used condoms”.  His girlfriend has never had an HIV test.  Stories like this is why HIV is so rampant in South Africa.  Then there was the slight young man who was on efavirenz and he opened his shirt and exposed breasts that any woman would love to have.  This is a side effect of efavirenz, it has estrogen-like properties.  So we stopped his efavirenz and started him on nevirapine.  Efavirenz also has teratogenicity to unborn fetuses.  Unfortunately, I have seen far too many pregnant ladies who were taking this very teratogenic drug.  I have stressed to my mentees the importance of not giving efavirenz to women of child-bearing age unless contraception is guaranteed.  Children will be born with central nervous system (CNS) malformation ranging from decreased IQ to malformations including microcephaly to anencephaly!

July 30, 2009

Today, as every day, was filled with unusual patients.  Everyone is different and yet so same!  We started so many patients on ARVs today I couldn’t begin to count them.  That was in Mathebistad.  Our first patient yesterday at Jubilee was a young man who had been having nausea, vomiting and diarrhea for three weeks!  He could keep nothing down.  He was so very dehydrated we had to start an IV on him.  The first patient today was basically the same, a young woman.  She wasn’t dehydrated, but HIV had made her so weak she couldn’t walk.  She had five children at home, none of whom had the HIV test.  Tomorrow I give the two lectures at Jubilee I mentioned in this morning’s e-mail.  Then Monday is the big lecture at Steve Biko Hospital at the Univ. of Pretoria on HIV resistance.  Please pray for me on the delivery of that one!  It will be in front of some of the most important physicians in South Africa.

On the way back from Mathebistad and still way out in the tribal area, I saw a huge crowd gathered at one point and one half of the road blocked off.  As I passed by there was a dead body in the road!  I have no idea what happened and I wasn’t about to stop and ask!! I think he had to be killed, probably in a fight, for there weren’t any vehicles involved.

I still have work on that lecture to do and I want to polish the two lectures for tomorrow. Au voir!

July 31, 2009

 It’s Friday!!!  The lectures this morning on Mother to Child Transmission (MTCT) and Lactic Acidosis have been given and there was good discussion and questions from the staff physicians.  I feel good about what I have been sent here to do.  One physician said I have left deep footprints here in South Africa and they have learned from my being in their midst. 

One lecture on Monday and two more Friday lectures to go and then I am on my way home!!  The first two patients were horribly sick this morning after the lectures.  They could barely hold their heads up or even sit in the wheelchair.  I don’t know why they wait so long to come for help.  It is as if scientific medicine is their last resort after the herbalist and the sangomas (witch doctors). So, so sad!  It was unusually slow all morning, but the patients we saw were sicker than usual.  There were sixty total patients seen at Wellness Clinic today.  Then we had a tutorial on reading chest x-rays at The Foundation for Professional Development (FDP) in Pretoria which was well attended.  So now work-week four has ended and there are two weeks to go.