Sights and Sounds in Durban

Just wanted to post a few pictures before heading out to the Braai (Africaans for barbeque) at our hostel.

I fly from Cape Town to Durban on Air Mango!

Mitchell Park - Rainbow

Me jumping into the Indian Ocean (for the first time; if wading off the coast of Goa doesn't count)

Funny sign outside of Indian Restaurant

The extremely cool new Durban football stadium (Moses Mabhida Stadium)

View from the top of the Stadium (by cable car) - Straight Down




Video from the top:

Durban

Hey all.

Made it to Durban after a wistful goodbye to Neeti and Didi (who unfortunately are still in S Africa! stupid 4 feet of snow in London...). Everything worked out in terms of timing, and although I just missed the airport shuttle by like 90 seconds (should have gone to the bathroom in the plane instead!) it turned out to be sort of a blessing in disguise because the airport shuttle driver was fascinating and I spent a lot of time with him (see below). Now I'm sitting at a really cool internet cafe called Cityzen, on Florida Road and Gordon Road in Morningside. It's a good time to reflect, just had a refreshing appletizer and a thin crust veggie pizza, and now I'm chillaxin' while I gather some thoughts about the past few days. Incidentally, the name of the place I got the appletizer was "Chill" -- I'm sure Didi would have approved :).

So -- back to philosophical musings -- I'm currently reading a book called "Breakfast with Socrates," by Robert Rowland-Smith, a fellow/lecturer at Oxford who is now a free-lance journalist. It's a very thought-provoking book about the "philosophy of every day life," in that he examines issues such as waking up, eating breakfast, and going to work -- and puts in his two cents about what he thinks famous philosophers would say about those mundane things. I really like his writing style, not entirely coincidentally because I've read most of those philosophers myself, in college, and it's fun to rethink about what JS Mill, or Plato, or Elaine Scarry wrote in a different context. I'm almost through it, but I can already tell it will be a highly recommended read (I can already imagine what Tony, Deip, Kallem, or Robbie would say about it!).

To go full circle again -- dunno why I'm thinking about Indians and Indian-ness so much this trip, but I bet Didi would say it's because I'm examining what it means to me to be an Indian -- I wanted to write about two encounters (already! and it's been less than 24 hours here!) with Indians in Durban. I go back to one of dad's main tenets, that Indians, everywhere the world over, are in general very sociable people who look out for their own (though I suspect many would be inclined to look out for *anyone*, really, viz. dad). The second encounter first -- I had a very cool stroll from the backpackers' this AM to the big Indian Bazaar in town, Victoria Market. It was a really nice walk, I had a fun time exploring the big bazaar and all the side streets, and only got myself lost about three times before I found my way around. I did buy some presents for mom from Sattar's Crockery (hope you like them, mom!). It started to drizzle, so I decided to walk back before the downpour came (luckily it missed us, I think...though I shouldn't speak too soon!). On the way back I took a bunch of side streets (don't worry, lots of people around, expensive cars, and lots of Indians; I think I blended in) and ran into a mom pushing a baby stroller with her 19 month old daughter. Baby's name is Aryanne, and they were on their way back from the park. We started chatting and Aryanne took a liking to me, I guess, so her mother invited me to a cup of coffee; that's when we went to Chill (and of course it was too hot for coffee, so Appletizer it was). It was fun, keeping little Aryanne entertained (but I realize now that I am desperately lacking skills in parlour tricks or other sleight of hand, and my most amusing trick was the old straw-mustache routine...). Her mother, once she found out about me traveling alone, gave me their family's contact info, gave me a standing invititation to join them for dinner, and directed me to a pizza place and then this cute internet cafe. She is half Indian and half Zulu (though, I must say, Aryanne looks all Indian to me). Again, it felt nice to chat with someone about being a second generation (or third, or whatever) immigrant, and issues related to the diaspora (interestingly, the mom reminded me of Didi's friendly optometrist from Cape Town, and in turn, Didi.)

But more to the thesis (I know, my blogging is so full of digressions), that Indians are friendly and look out for other Indians (me), I wanted to write about my airport shuttle driver. His name is Prahlad, and he's actually a mechanic, who works 6 days a week in the Engen gas station repairing cars, and on Sundays he does an airport shuttle shift. He was the one who told me I missed the previous shuttle by 90 seconds; he told me he was waving and honking as I came wandering out looking for the shuttle, so that he could get me to run after the previous shuttle, but apparently I was looking in the wrong direction. So we started chatting (I had to wait another hour before his shuttle was allowed to leave), and we talked about everything from cricket (hooray for Tendulkar's 50th century! boo for the poor Indian first day's performance...) to the scandal about the Cape Town kidnapping. He told me about his family; one daughter who completed her law degree and works in Joburg, and another who is finishing undergrad this year. He also expounded on his religious persuasions (Hindu, no meat on Mondays, Tuesdays, Thursdays, or Fridays; prefers the smaller Hindu mandir in the suburbs to the big Durban mandir). He did this all while driving through crazy traffic, lots of people honking at him, passengers being annoying (misstating addresses for drop offs; not being on time for pickups), and was really remarkably calm through the whole thing. He gave me two options to drop me off; either first (since I had been waiting the longet), or after everyone else (in which case he could give me a personally guided tour through Durban's city centre). I chose the latter, and it took about 1.5 hours but I got a really good sense of the city, and visited pretty much all the sights/sounds/beaches (though surely I will repeat it on foot if the weather improves). He also stopped in the middle of the road for an Indian family (Gujrati, from Mumbai, but living in Brazil for work currently) who were getting drenched by the downpour, and offerred them a ride to their hotel. He was really nice, and I'm glad I got to spend time with him.

So there, maybe people are really friendly everywhere (Didi's experience in Istanbul was rather incredible, too). But I'm pretty happy being Indian while in Africa. :)

people of cape town

South Africa is a very unique place, in Africa for sure but also more broadly in history/world affairs. I probably won't get all the history right, but it was only in the 1990s that apartheid ended, and it's taken even longer for racial integration to really take root. It's weird because the English and Dutch abolished slavery a while back (even before it was abolished in the US), but the ruling elite of SA were comprised of wealthy whites who did all they could (and rather ridiculously, in retrospect) to maintain social/class divisions along racial lines. Clearly integration after many many years of segregation takes a long time -- the change in the legal books has to be followed by fairly radical changes in the hearts and minds of the people (thanks, Bailey, for the phrase). In the US, for example, Brown v Board of Ed ruled in 1954 that public schools could not be segregated, that "separate but equal" was not even pretending to be equal. And even today, years later, schools (like my own, no doubt - maybe one black family in the whole school when I was there?) have de facto segregation (laudations to Jyo's school, for bussing innovations).

But South Africa is wholly different -- the apartheid laws were *not even meant* to have people be equal, only to have them separated. It's appalling to think about how/why the international community allowed this to remain in place *well* into the end of the 20th century. And because of the slow legal forces of change, the change in people's attitudes has been even slower. Now, I should back up and say that Cape Town is one of the most vibrant, multicultural, colorful cities I know (and certainly in Africa). A lot of great research comes from the University here that affects people of all walks of life (I gave Journal Club on this article re: pre-exposure prophylaxis, one of whose sites was Cape Town). But we've all (Didi, Neeti and I) experienced subtle attitudes towards us that make us question -- for only the second time in my life, the other being Japan -- whether we're being treated differently because of the color of our skin. It's unnerving, and in some ways has diminished my experience here. That being said, there are some pretty amazing people here whose stories I'll get to later (to end with my endless optimism, or course :).

A few examples of the former -- the first night we were at Asoka, the fantastic jazz place, we were initially turned down for a table. It was 8.15p, the jazz was going to start at 9, so we thought we'd actually be a little early. But apparently, the waitress said, "we're completely booked, and the waiting list is really long; I don't think you'll be able to get a table." We finally asked to be placed on the waiting list anyway, opting to sit at the bar until that table opened up (we were quite willing to just order our food at the bar and wait it out, so that at least we could hear the jazz). She was very brusque, as if we were not really interesting enough to stoop to conversation with. We sat down, made ourselves comfortable, asked for menus, and were vigorously debating our appetizers when the waitress came back very suddenly and told us that a table just opened up for us. It had been only 3 or 4 minutes...

She was white, of course. Looking around, there was only one other colored group in the entire restaurant. Sure, it could have been a last minute cancellation, but she hadn't even entertained that possibility when she first saw us. It was really annoying, this manner of dismissing us...it was weird because, I think, we were among the better dressed people there, and we clearly were willing to spend money on the dinner, so I don't know why she would have treated us like that. In any case, the actual waitress we got was very nice, and we had a really nice evening of jazz after that.

And today I went to the famed Clarke's Books because it caught my eye as I was on my way to breakfast (needless to say...I spent so much time in there that breakfast never happened, and I had an excellent veggie burger at Royale Eatery instead!). As I was going in, an elderly white woman was entering before me, and I attempted to catch the door before she closed it on me. It was a weird interaction; you do have to ring the doorbell to enter/exit the store (as a safeguard against shoplifter, presumably), and I can only guess that she was slightly suspicious of me entering behind her without ringing the doorbell on my own. Which is weird, but whatever. Then, literally as I was halfway through the threshold of the door, she turned around very quickly and asked me in an impertinent voice, "Yes, Can I help you?" I must have looked slightly shocked, if not outright offended at her insinuations (whatever those were), and she repeated in a softer tone, "I work here." I told her I was just coming in to browse, and she said, "You can go upstairs too, but you have to give me your bag before going up." Now, that policy was posted on the door, so I was fine with it, but I was annoyed that she singled me out (there were three other, white, people in the store) and repeated that to me, as if otherwise I would have gone up there to shoplift her books. I decided to give her the benefit of the doubt -- maybe she's just rude to everyone, maybe she just had a huge shoplifting last week, maybe she's just having a bad day. But it took me a while, almost a half hour, before I felt okay after that. I did enjoy Clarke's -- it was wholly unlike Book Lounge (Brookline Booksmith's equivalent), but similar to, of all things, the library at Wadham College, Oxford. The entire upstairs was a second hand book store, and it had the faint musty/dusty smell of an old English library. Things were also really well organized on the shelves; nevertheless there were piles and piles of books seemingly randomly strewn everywhere. I picked up two interesting books; one called "Playing God," which feeds into my unsupported but vigorously argued case for the Great Man theory of history (it's a book about 7 pivotal meetings between influencial historical men and how they changed the world). The other is "Breakfast with Socrates," philosophical musings about what famous writers/thinkers might say about mundane things like going to the work, or to the doctor. I'm excited to read these between Le Carre and Larsson on the long plane ride home.

We have also met some fairly incredible people here. Really nice locals, all involved in the tourist industry in some capacity (maybe it's self-fulfilling?). I already wrote about the Marine Dynamics people who were really nice (and the captain of our boat later sent Didi, Neeti, and me a few of his "special" snapshots (low resolution, unfortunately) -- really cool pictures of the sharks he's been tracking). Yesterday our tour guide was really nice, but just an amazing person. Apparently he was born to poor slightly-less-than-caring parents, who just thought their son was stupid until he was 10 years old, when someone finally figured out that he wasn't stupid, but deaf. He had gotten through life just lip-reading before then, and finally had a very simple surgical procedure to retore (actually, to *give*) him the gift of sound. The first words he heard out of his own mouth were "Can I have some ice cream?" :) He was told not to swim, play sport, or do anything that might imbalance his ears; of course he took this as a challenge and became an expert swimmer, doing 50 olympic-size laps in the local pool every morning. Then, at age 16, he developed mastoiditis (unrelated, maybe, to the swimming?) and was told by a doctor that he would die within 1 month. He got IV antibiotics, however, and had a miraculous recovery from his septic state after a radical temporal bone resection, and he did really well post-operatively. He grew up more comfortable in the bush than on streets, so developed a great relationship with animals like ostritches and vervet monkeys. He did odds and ends, until a friend suggested he become a clown, which he did for the better part of a decade before he got tired of the little kids kicking his leg (he had a bad left leg, from a previous accident). He quit, and became a tour guide instead, because he loved meeting new people and learning new things about the world. He was a really cool guy, and he played different types of music for us throughout, and tried to give a flavor for what Cape Town is really like. Very inspiring guy too; you can tell he loves what he's doing now because he really has a passion for it.

Anyway, I've rambled on too long now. I have to head back to the apartment, get an inventory of our supplies, and then head to the grocery store. I'm cooking dinner for Didi and Neeti tonight, and hope to have it ready by the time they get back from their safari. Dinner will be simple; some apricot cheese fresh from Fairview Farms with grapes and crackers to start, then the famous grilled eggplant parmesan (white and red sauce, grilled peppers mixed in) that I always make. Dunno about dessert yet.

Leaving you with a few images from last night -- sunset over Camp's Bay.


Then a reflection of that view from a combi/minibus.

Cape Town - slow it down

Today was another relaxing day in C^2. It's funny what nicknames people give to cities. NYC's the big apple of course. But I'm not sure what to call Cape Town. C-Town? C-squared? I think the locals just call it "The Cape." Unclear.

I've settled into a nice routine here in South Africa. Since Didi and Neeti came, I've been getting up early and doing 15 min of P-90-X inspired yoga to get the day started. Then today I settled down with a cup of red bush tea while people watching from our excellently large bay windows.

Yesterday was a late night (the jazz at Asoka was awesome! they started with a Miles Davis piece but then quickly moved on to either really loose interpretations, or just their own stuff that I haven't heard before. There was a trumpet, bass guitar, keyboard, and drums.). But when we got home I saw Neeti's copy of "One Day" by David Nicholls sitting on the coffee table, so I decided to read it. So I slept at around 6am, and then was up doing yoga by 8am. I feel surprisingly refreshed, but am waiting for the crash to come soon...

I walked to a very cool bookshop (The Book Lodge; think Brookline Booksmith) and spent a few hours perusing the upstairs fiction section before discovering there was a whole cafe/lounge and nonfiction section downstairs! So then I settled down with some Goethe and Neruda; it was cool because both collected works had the spanish/german on one side and the english translation on the other. I always like to see/hear what the original sounds like; it's just so much richer. Especially now that I understand some spanish, I really like at least hearing Neruda's words before inevitably reading the english interpretations for deeper meaning. Is it funny/ironic/surprising that my largest purchase in cape town so far is books? I almost went nuts and bought six books this morning; I did tone it down in the end and only came home with 3. Two are just for pleasure reading in the gardens and plane (the last of the dragon tattoo series; and Le Carr's famous tinker/tailor/soldier/spy). But one of the books was a special purchase.

As I was walking to the bookshop I took the scenic route around the Parliament. I saw squeezed in between two governmental buildings a cornershop with lines of books by the windows and a handpainted ?cardboard sign that said "Bookery." I was intrigued, so I went in. Apparently, it was the head office for an organization called Equal Education, whose mission includes a "One School, One Library campaign" because a lot of South African public schools don't have their own library. Jyoti and I were just talking the other day about how much we loved our elementary school libraries (of course we spent more time there than any other school room...) -- the smell of the old books, the thrill of discovering an author then reading the whole shelf (Arthur Clarke, Babysitter's club, whatever), etc. I met the guy who's running the campaign here, and his mission is to get books donated and build real libraries for all these kids. I told him I'd be back with old novels when I had a chance. But then at the bookshop I found a cute nonsense cartoony kids book called "A Wanderer in Og" whose sales proceeds went directly to EEs Bookery. So I bought a copy (for Jyo, really, not for me...).

So now I'm at DLL (the usual hangout, for free internet/cool music/interesting people). I had only a small snack earlier, so I think I'll find something to eat, then read a little in Company's Gardens before meeting up with Didi and Neeti for Table Mountain and the sunset on Mission Hill later tonight.

Cheers,

P

Shark Cage Diving

We're alive! Yay. Neeti, Didi and I decided to wake up at 5am and get driven 2 hours toKleinbaai, on the southern coast of South Africa (near where the *true* meeting of the Atlantic and Indian Oceans is). We were, to say the least, frigid -- it's not really all that cold here (it's summer after all), but with 34 km an hour winds blowing at us it sure feels cool!

We were nervous but our fears were allayed by the really cool marine biologist researcher (Alison) who assured us that everything would go smoothly. Which it did. As luck would have it, we were dilly-dallying around in our wet suits (quite stylish, I know) because we were nervous about getting into the cage after the first shark sighting -- but there were four people already in the water, and then there was only room for three more, and no one else wanted to go in. So Didi seized that opportunity to take the plunge, so to speak, and she went in the cage. Neeti and I soon followed, and the water was incredibly cold...but the allure of seeing a shark from 2 feet away was enough for us to conquer the cold. The baitsmen (likely just local kids who were interning on the marine biology cruise vessel for a summer holiday) had a lot of fun hauling the bait (the head of a large fish) and a decoy (wooden plank) into the water in front of the cage, and watching the sharks go after it. We saw three sharks (all male, all juvenile 2 meters long) while we were in the cage, and then after resurfacing we saw another 7 sharks (10 total!) including a massive 4 meter male. It was, to put it bluntly, exhilarating.

Here is an awesome video of one juvenile (yes, it's a small one!) Great White Shark getting baited but then actually snapping the fish off the bait line:

Favorite line of the day: "Who thinks it's ironic that *we* are in the cages and the sharks are roaming free?" -Didi

Some more pics, since the video doesn't seem to be loading on most computers:

(Isn't it odd that a baby shark is called a "pup"? Sharks and dogs don't look anything alike...)

(Yes, that red line is the decoy bait, and yes, it is literally 3 feet from us in the water!)

Well, that was pretty darn cool. Now we shower/change and go out to Asian fusion food for dinner and some local jazz afterwards.

BTW -- a plug for responsible eco-tourism; I really liked the message that Marine Dynamics (not to be confused with Veridian Dynamics) gave us. We had a 10 minute powerpoint before we began outlining the research they do, how it helps the sharks overall given their status as an endangered species, and I appreciated having a marine biologist and not just a tour guide on the boat. Highly, highly recommended group.

Cape Town

Hi everyone!

We've had a whirlwind of an ending to our trip in Africa (well, ending for Jyo, just beginning for Neeti and Didi, and sort of ending and sort of beginning for me!). Jyo left yesterday, so I am somewhat blue (I am indeed wearing blue HUP scrubs as I type) but there's so much exciting stuff to talk about hopefully you'll get excited too, by proxy.

We left Gaborone and PMH a day early; Fri 10/12 in the AM. It was difficult but nice to say goodbye to all the new friends we made: Shruti the immunology PhD who's attempting to do something amazing by setting up basic science research at the U of Bots; Marisa (who knows all about Edgemont from her partner!), an Ob-Gyn doing a year of epidemiology research in maternal mortality; Adam and Shira, a researcher and a comedy writer (who really are hilarious) who had to get married to retain visas to stay in the country; Paul, another premed researcher who got me really excited for my upcoming trip to Durban; etc. Facebook is such an excellent invention, and hopefully we'll be able to keep in touch for a long while yet. Not to mention Mmuluki and Felecia - the Bots MOs, and Nadia/Tonusha/Evange, the trio of Australian Med Students. We all enjoyed a lovely last night's dinner at Bull & Bush before we left.

When we got to Cape Town it was, to use my favorite catch phrase of the weekend, "ridiculously windy." We almost got blown away just standing there! Our grand plan was to hike Table Mountain that evening to watch the sun set -- but we never made it up there, seeing as how the cable car was closed due to inclement weather. We decided to walk around instead, and had a wonderful time exploring the little neighborhoods of Cape Town. We strolled in Company's Gardens, and found a cool Indian fast food place (reminds me of Galaxy foods in Edison; before it burned down, that is!) where we got a bataka paratha and palak paneer and dhai puri made from scratch by a Gujarati chef who kept talking to Jyoti in Gujarati (she kept her own, let it be known).

We stayed at Daddy Long Legs hotel, which is a really cute, extremely central, and overall fantastic place to stay. The people were so friendly; calling the cable car at Table Mountain, directing us to the best spots to walk around, etc. I'm really glad we chose it; it was perfect. The room we had was lined with records (oh, if only the record player worked!) and books of poetry(Tony, the perfect place for you and Julia should you ever come to Cape Town!).

On Sat 11 Dec we took an all day Cape Peninsula tour that hit the highlights of the city and surroundings. We were joined on our tour by a New Orleans couple (Bryant and George), Libyan tourists, and an Oregon/Florida couple (Fletcher and Kristen). Here's a picture at Cape Point:

Bryant and George are lawyers who do nonprofit work for people with HIV/AIDS. The Libyan tourists were a mechanical engineer (who has traveled very very extensively, very impressive knowledge of the world; only lacks a trip to the US!) and his friend. Fletcher and Kristen are ex-military types who do defense contracting in Afghanistan, and have also traveled a lot. Very cool group, we enjoyed hanging out with them.

We were tired, but in an exhilirated/excited way by the time we got back. We showered/cleaned up and then went for a long-ish walk up to the Victoria & Albert waterfront, and saw the sunset on the Atlantic for the first time! It was quite a site; similar what I'd imagine the Oregon/Washington coast line to be (alas, we never made it to Olympia when we were in Seattle; we'll have to go back to make a fair comparison). We had a really tasty thin crust pizza on the waterfront before heading back for an early night.

On Sunday morning we had the ambitious plan of hiking Table Mountain (3 km of straight uphill, 1 km elevation!) before lunching before Jyoti's flight at 4p. We made it! despite our poor planning, relative dehydration, lack of breakfast, late start, lack of sun protection (oh, helioplex, where were you when we needed you?!) we did the Plattyklip Gorge route in just under 2 hours (well done, Jyo!). We had only one wrong turn along the way, but had some pretty spectacular views. We met all sorts of interesting people, including a dog named Marty who first climbed Table Mountain at 4 months of age; a 5 year old French boy hiking with his dad (very brave!); a group of extremely fit English who lapped us on the way up; and a black South African nonchalantly walking up with only flip flops (he also lapped us...). Too many pictures/memories to put down here, but here's a video Jyo took.

(Again, videos don't seem to be uploading from Daddy Long Legs, so here's a picture of us from the top. Doesn't do it justice, but to really appreciate it, you'll have to come visit Table Mountain yourself!)

We made it back, had lunch at a cool Caribbean Restaurant, and then it was time to say goodbye to Jyo :(.

After Jyo left I decided to explore the city by foot. I walked around to the Castle, saw an outdoor high school jazz band concert, walked through the gardens again, read a book, saw the Parliament House and the National Gallery (small, but nice), read some more, and caught the last part of a football match at Dubliner's, an Irish Pub. I had dinner at the Indian place again, and then came back home to read some more before turning in for the night. I slept so peacefully; the hike in the morning and evening walk was tiring, but well worth it of course.

Today Didi and Neeti come! I'm very excited. I'll pick up the apt keys and meet them there in just a few hours; hopefully everything has gone smoothly since the original delay at JFK.

More adventures: shark cages, more tours, white sand beaches, drives to the western countryside, and of course a whimsical trip to Durban -- yet to come!

Cheers,

Parin

Random

Two things I never had a chance to blog about: 1. a 37 degree Celsius Thanksgiving; 2. Swaminarayan Mandirs in Africa.

1. on 25th Nov 2010, Jyoti spent her first Thanksgiving ever away from Rochester. It was a sad affair, as neither Kandlikar girl was home this year. But we did manage to gather our new Botswana family together for a large, football filled, Thanksgiving feast (no Turkey Trot, I'm afraid). Jyo was stuck late at work, so I was given the task of preparing our portion of the meal. I decided to replicate the apple crisp Jyoti had made the week before, and I also threw together a chipotle creamed twice baked stuffed potato skins.

In case you were wondering, the chipotle was indeed imported from Philadelphia. :) The list of friends we made is long, and we had tons of delicious food and lots of veggie stuff for us. Mouth watering, no?

2. Botswana does have a sizable Indian population (though nothing compared to Durban, I'm sure). We managed to make friends with one family who -- random! -- are Vadtaldham Swaminarayan from Amdabad. There is not a big enough contingent to have a Vadtaldham mandir here, but we did go to Satsang when BAPS swamis came from India/Kenya on 1st Dec. The mandir is small but very pretty, and it was really nice going to the mandir here. Here is a view from the side:

And the nar narayan swaminarayan murthi:

Victoria Falls

Saturday, 4th Dec 2010

Jyoti and I took a day trip to Victoria Falls, on the Zimbabwean side. This turned out to be a fantastic decision given that the Zambian side gets to see only 1/10 of the falls.

To chronicle our trip in photos:

1. we alighted the minibus at the grand Victoria Falls Hotel (built ca 1904). Here's a picture of us about 3 km away from the falls in the hotel's backyard.

2. next was a view of the falls from about 150 m away, at a spot known as Devil's Cataract (not pictured here, but it's a side falls that's much smaller but also impressive).

3. here I am at the main falls, from another lookout point, this one the closest at 93 m away. The picture is dark and my shirt is drenched because the falls actually spray enough water in the air constantly to create a unique tropical rainforest biome on this side of the river!

4. now we've passed the main falls and wandered over to the "danger point" which, when it's rained more and the falls are bigger, can be a slippery slidey place. Right now since it's just the start of rainy season the water is actually fairly low and there are just a few side falls dotting the cliff, not one giant falls extending over the whole wall. Still rather beautiful though.

5. a video, and our favorite pictures from our favorite view: main falls from 93 m. We even came back for a second viewing, and the second time around we had a surprise visit from a rainbow!

6. Finally, we had lunch at the Island Cafe, in the elephant mall. Despite Victoria Falls not having electricity (apparently this is common in Africa!) the cafe was able to make us a tasty strawberry milkshake (hand mixed; ice cream only partially melted from the ice bucket) and brick oven pizzas. We met up with friends from the tour and had a good time. There was much musing as to the origins of the "blue baboon special" pizza (see blog entry "Tau Lodge") and the differences between Botswana and Zimbabwe (they were Motswana, one living in South Africa and one in Gaborone).

The only souvenir I decided to buy was a CD of Goliath Phiri, who plays as part of the Sinsika Marimba Band. We were entertained by this performance while we tried to shoo away the more aggressive craft traders.

Overall a very good trip, no snafus at the border, and the view was worth it. May be worth a second visit after rainy season next time!

Chobe

We just got back from our trip to Kasane (city) and Chobe (River, and National Park). We stayed at the Chobe Safari Lodge, which came highly recommended by friends, and did not disappoint. We did an evening river cruise the first night, a day trip to Victoria Falls, Zimbabwe the next day, and just relaxed at the Lodge on the last day. There was much reading of Alexander McCall Smith during this trip. Something DT would be proud of: an abundance of quiet reading time ;).

After alighting the aircraft, we met a German couple and two American International AID workers who were on our flight, and also following a similar itinerary. The river cruise was pretty spectacular, and though we did not see elephants bathing (Jyo's wish), we did see hippos fighting (my wish). More on that later. Here we are, eager to get the boat ride started (for which Jyo did not even need her dramamine!).

We went to Sidudu Island, apparently shared by Botswana and Namibia, and saw a lot of impala and various birds. Here is a pretty awesome picture of two kingfishers perched on a barren tree. I think they're green, but a higher power zoom would have been nice...

We also saw this heron digging in the softer parts of the grass for edible items. I wasn't even aware of its presence when I snapped the picture, but the lower right hand corner has a surprise guest...

...6 foot viper!

Here is a female Kudu interested in our boat. But notice on her back -- she's got a free rider! The bird apparently has a symbiotic relationship, as it keeps her fur coat nice and clean from bugs; in return the bird gets an easy meal and a free ride.

Similarly, these birds following the hippo get the choicest bugs that hide out under the turf; after the hippo chomps on the upper layer of grass, the birds get clean and clear access to the hidden insects. I'm not sure if the hippo gets anything out of it though, so the relationship may be more commensal.

This last relationship, however, is anything but friendly. It must have been prime mating season or something, because the hippos were out in full force and battling for turf. The angle never was perfect, but here's a short clip of two male hippos going at it!

Finally, the view of the sun going down over the Chobe River were spectacular. The really cool thing was that it was cloudy and raining in Namibia across the river, so while the sun was setting there was thunder and lightning just slightly to the north.

"clinical experience"

As the adage goes, don't judge a book by its cover. Or, as it turns out, a professor of pediatrics by his rounding style. Initially, the prof rubbed Jyoti the wrong way, as he rounded only twice a week, and seemed to know very little about each patient, making split second decisions based on a limited data set. I ate my words last Thursday, when prof proved to be quite a compassionate, not to mention extremely competent, head of Pediatrics here at PMH. After a blitzkrieg of rounding in the morning, Jyo's MO and med student disappeared, and she had the task of arranging a chest xray for a young baby who appeared clinically well. The baby had come in with a fever, was written for IV antibiotics, and was looking tons better despite not even getting the medicines yet. Jyo attributed the improvement to just some gentle encouragement of hydration and feeding, which the baby seemed to enjoy. Now he was playful and laughing, looking ready to go home. However, prof did a fairly cursory exam, pronounced "decreased breath sounds on the left," and asked Jyoti to continue antibiotics (i.e., start them) and get a chest xray to rule out pneumonia...so Jyo performed her task and by the afternoon she brought over the fairly obvious radiograph for me to review. There was a large left sided infiltrate consistent with pneumonia! We realized that maybe the prof did, in his own way, take pretty good care of his patients, and his fairly extensive clinical experience made for good clinical judgement in many cases. And on a related note regarding his compassion: he discovered that due to some technicality in the governmental rules, babies in Botswana can get free formula only if their mother is HIV positive, or if they have been abandoned. The baby in question had failed to regain birth weight after 2 months because of severe malnutrition. The mother's milk supply had dried up, and several older siblings had already perished from malnutrition. HOWEVER, because the mother was not HIV positive, the baby got no newborn formula from the government, and the mom could not afford any milk for him (she was G8P8 and destitute). The prof was rather frustrated by this pronouncement from "the management" that he walked a half hour in the rain to the nearest grocery store, bought a month's supply of formula out of pocket, and gave it to the baby's mom. I liked the prof even more after hearing this story -- there are others like him at PMH, for better or worse; those who subvert the unnecessarily complex red tape by taking matters into their own hands so that patients are better served. For example, John, a NICU doc here, was outraged that Zimbabwean babies do not get HAART, so he bought a stockpile of AZT and supplies it to mothers at his own expense. Some would argue that this approach has its drawbacks; it does nothing to change the current inequity, and may crumble quickly if the prof or if John left abruptly, after perhaps spurring reliance on such efforts to get basic health care (though John is making it more sustainable by setting up a trust fund of sorts). But as physicians who take care of individual patients every day, it's often difficult to look past the patient in front of you, whom you know you could help with a simple intervention, to worry about what downstream effects your actions may have. In that sense, I'm glad Penn has a really well developed, well thought out relationship with U of Bots. I know long after I'm gone, there will still be a healthy and productive partnership between the two entities. And it helps that my replacement come January will be none other than Mosepele Mosepele, whose return many of the nurses here are already eagerly awaiting (he is a Motswana MD who did training in Australia, returned to Bots for an MO year, and now a 2nd year resident at HUP). :)

Resuscitation

Two different stories of two different resuscitations today:

1. Jyoti was taking care of a 2 year old with paraffin ingestion/poisoning. Now, neither of us had heard of paraffin before coming to this country, but given that it's a product that's found in diesel fuel, we figured it was not very good for this kiddo. My guess was a waxy petroleum substance (reminding me of "parafilm" that we use in the lab all the time); Jyoti's suggestion was that it was a liquid nonabsorbable nonpolar organic compound (given that she uses "tincture of paraffin" as a laxative for other patients...). Dr Google says...we're both right; it is the general name for any alkene hydrocarbon (the octane found in gasoline, and the kerosene that the baby most likely ODed on are both examples). Well, the kid looked ok, but yesterday Jyoti saw that he was in mild respiratory distress, and was tachycardic though had moist mucous membranes. Given that the team was electing to keep the baby NPO, and that the baby was trying to suck the moisture out of its own thumb, Jyoti ordered IV fluids. A specialist attending later decided to cancel that order, because the baby "looked well." Today as Jyoti prerounded with her medical student, the baby literally turned gray in front of their eyes, and stopped breathing and underwent cardiac arrest. Apparently he was really quite normal this morning before that. The team rushed in and resuscitation was begun. Despite intubation and fluid boluses and chest compressions, the baby expired after an hour.

2. As I walked into the ward from lunch, the intern quickly pointed me towards cubicle C, where a patient had just become unresponsive. The patient was a young female, 35 yo, with HIV not on HAART, who had come in with vague abdominal pain concerning for an acute abdomen. A surgery consult had just seen the patient a few hours earlier, and decided that there was nothing acute about her abdomen. But by the time I saw her, her abdomen was huge and tight and hyperresonant, almost certainly indicating an abdominal catastrophe. She had had fevers but no antibiosis was begun. As the senior medical person there, I was asked to run the code -- which is ridiculously different from running a code in the US. For one, there is no heart monitor, so at most we should really only be doing Basic Life Support, not Advanced, given that we have no idea whether the lack of pulse means VFib, VTach, asystole, or PEA. But apparently that's not how it's done here. I attempted to lead everyone in BLS, getting very effective chest compressions from an MO (whose patient this was) and good ambu bag breaths from the nurse/orderly. Given the lack of information about the electrical activity of the heart, I figured that epinephrine couldn't hurt, since it's common to almost every pathway. But my intern and MO kept trying to go through various algorithms, which didn't quite make sense to me given that we didn't really know what we were treating. So we ended up giving epi and atropine for a few rounds, while doing 15-2 chest compressions to rescue breaths. This was an interesting mix of BLS and ACLS...but I went with it, and tried to review all reversible causes with the team; my leading diagnosis was abdominal catastrophe and sepsis, which would only get better with fluids (which she was getting), aggressive antibiotics (which were out of stock today), pressors (which we don't have), mechanical ventilation (which we don't have), and surgery (once she was stable). But I figured it would be good teaching to review the 5Hs and Ts of PEA, which most people appreciated, and we did end up giving some bicarb as well. And to top it all off we finally got a defibrillator there, but there were no pads to read the rhythm (they had fallen off and were nowhere to be found). There were defibrillation handles, so we ended up shocking once as well, figuring it probably couldn't really hurt. I guess it was a reasonable learning opportunity for those involved, but I was pretty sure that as soon as we got there and I saw her belly, there was not much we were going to be able to do.

I wonder if Jyoti's patient could have been better managed prior to the code, or if something happened suddenly between 6 and 7 am to make him decompensate. I truly think it's the latter. I think the adult patient was really sick, and I'm not sure if the surgical team missed something this morning; then again, she was so sick that she may not have survived a major abdominal surgery. And given that our ICU is effectively closed to any sick HIV patients, I'm not sure there was much we were going to offer her. But after going through a resuscitation effort here in Botswana, I think there are a lot of things that could be improved. a) have pads on the defibrillator! b) have a mechanism in place to care for a patient after resuscitation has been achieved (or else it's futile!) c) house officers should review evidence based guidelines for resuscitation and apply them to what the hospital can offer. this should be a hospital wide policy, so that people don't just pick and choose some things from BLS and some things from ACLS...

Hospital Woes

So, I know this is supposed to be an elective rotation for us (and a CALL-FREE rotation, despite Jyoti's mandatory 5 call nights this month) -- but it's probably bad news when you're the hardest worker on your team. My team is probably the best medicine team to be on (MO who really knows his stuff, tries to get patients out quickly and safely, and has a great attitude; intern who [sometimes] tries hard and is generally willing to stay late [it helps that her husband is in Australia]). But the pace of life here is so slow, and it spills onto the wards as well. That means that something that should take 1 hour ends up being stretched into 2 or 3 hours, and this compounds the time spent in the hospital (unnecessarily). For example, AM report finished a bit late, so rounds started late. But the MO was post-call, so he went off to eat breakfast before rounds, and asked the intern, me, and the med student to start rounding on the old patients. So we three gathered at the Male Medical Ward to start rounds. But then the intern said she lost her N-95 mask and went to go find a new one. So the med student and I rounded on three patients (almost 30 minutes) before the intern came back with a mask. I'm not sure if it really does take that much time to find a mask (and it very well could take that long; finding a pair of gloves on Monday took about that much time), but I'm betting that some of that time was spent catching up with other interns, musing about the weather, etc. There's just no sense of urgency. We couldn't communicate effectively with one patient, so the intern had to go back and redo what we had just done...so inefficient! And the real trouble is that little things like that add up throughout the day, and before you know it 5 0'clock rolls around and there are still things left to do. They either just don't happen, or get pushed to the next day, which extends length of stay unnecessarily! And when I try to be more efficient and do things myself, the intern complains that she's not getting enough autonomy. I've decided that I'll just try to help out where I can, but ultimately I am not here to change the pace of anything.

But Jyoti's team is even more exasperating (notice my use of that word twice in the last two blogs; it's a good one). Her team consists of herself; an absentee attending (old prof who makes split second decisions based on vast years of clinical judgement); a hard working intern; a med student from Jamaica who's treating this month as a half day only rotation; and an MO who makes unnecessary statements like "I don't like Americans" on rounds. Today was a call day for her team. After Jyoti gave a fantastic presentation on fetal cardiac development for morning report, the team lounged around until rounds, from 9-10. Then her med student left for the day. Her intern had to go home to let the cable guy in. And her MO promptly exclaimed that she was tired and went to take a nap. Which lasted well into the afternoon, as we didn't see her again the rest of the day (keep in mind the MO was on call today!). This left Jyoti to essentially do all the work for her team the entire day. When she asked the MO to do some things before the nap, the MO replied "nothing is really that urgent." I can only image what would happen at HUP or at CHOP if anyone acted like that!

It's amusing in retrospect (really? the cable guy?) but I'm not sure how medical care can be changed to fix these issues. Maybe they're not really issues at all, since Batswana people tend to accept the care as given? Still can't help thinking there's got to be a better way to deliver medical care...

But, to end on a lighter note -- we thought this was hilarious. My theory is that it's where kids go to give a sample to test for TB. Which is odd, since kids supposedly lack the diaphragmatic fortitude to be able to cough up TB. Jyoti has a better idea -- if you happen to be passing by the IDCC building, and you begin to have a coughing spasm, this little shack is where you go to remove yourself from others' company. It's the polite thing to do, of course. Any other ideas?

Khama Rhino Sanctuary

We just got back from the National Khama Rhino Sanctuary. Apparently all the rhinos were dying in Botswana (mainly poachers) so Khama, the first president of the country, decided to set aside land and create a true Rhino Sancutuary. Some rich guy was persuaded by the Botswana Government to donate his land near Serowe, and they brought over 33 white rhinos and 3 black rhinos from across the country to habit the area. It's about a 16 square mile area that has 3 prominent watering holes, all naturally formed (but sometimes abetted by pump water when the land is particularly dry). It was cool to hear the Batswana tour guide talk about her country, the history of the sanctuary, and the rhinos; there was more than a trace of pride in it. A little different experience than the luxury of Madikwe.

We took a bus from Gabs to Serowe (4 hour ride, relatively pleasant once we got going on the A1 main highway). We wandered through the main mall at Serowe once we alighted, and ran into a nice indian aunti who pointed us toward the Tshwaragano Hotel, which is built into the hill that houses His Excellency Sir Seretse Khama's grave. It does provide a nice view of the whole town ("the biggest village in Botswana" we were told). It was a cute bed&breakfast that served us chips and beans&toast, along with milk, juice, tea, and fruit. They were quite baffled when we said "no eggs or meat" but managed to get the breakfast right in the end. :)

Getting to the right place was no problem, but once we got there we were sort of stared at blankly. It's something that I've noticed a lot about Batswana, something that Mosepele warned me about before we left -- I called it "underhandedness." The lady at the front desk basically said nothing and waited for us to explain why we were there. We tried to ask about any game drives departing soon, and she continued to stare at us blankly, then in an exasperated soliloquy to no one in particular, said "some people are just very difficult to understand." It would have been much more pleasant for her to directly ask me what I said, or to repeat something; but in Botswana people tend to wait for you to figure out that they're confused and want something more from you. It's as if we're supposed to take very subtle cues from the head movement, or body position, or respiratory rate, or something else that I must be missing...!

In any case, we ended up having 3 hours to kill before the next game drive. It rained on and off for those few hours while we chillaxed at the Sanctuary, but when it came time for our game drive the weather cooperated very nicely. Jyoti took this artistic picture of a tweetie bird's nest (apparently they're called "yellow weavers").

There was also this blue-monarch looking butterfly interspersing with some angry looking hornets around the swimming pool. Yes, we could probably use a lesson in entymology (it's blue, and has eyes like a monarch butterfly...).

A lot of the animals we had seen already (Kuru, Impala, ostrich, spring bok, etc.) so although we continued to take lots of pictures (what do you do with a 4 GB disk drive anyway?), I will only post some interesting pics. This one is a bird looking into the distance, enjoying the shade of a brightly lit cloud.

Here's Jyoti with a background of zebra. We learned that Botswana Zebra have not just black and white, but brown as well, whereas South African Zebra have just black and white.

And of course, what would a Rhino Sanctuary be without rhinos? We did see a few white rhinos, but no black rhinos. I like the bird just chilling at the feet of the baby rhino (2 yr old; after 1 more year with her mom she'll go off on her own!).

We also encountered a cool new species of gazelle called "Oryx." I love the black stripes. Probably the coolest animal I saw at the sanctuary.

And here's the sun setting on us as we leave the Sanctuary...

Life at Princess Marina Hospital

Though the blog is appropriately titled Travel Notes, I do occasionally go to work while I'm here in Gaborone/Botswana (though don't tell Customs this; officially I'm here for "7 weeks of holiday"). We had a crazy busy call night on Wednesday, and so Thursday/Friday was spent getting to know the 16 new patients (we were entering call with 14) and trying to get through all 30 patients on rounds. It turns out our attending (Specialist Dr Ditlotlo) has clinic on Tuesday and Wednesday, so she only rounds with us 3 days a week (except for when she has random meetings on a Thursday...). The Medical Officer (Moolooki Mathake) and I run rounds and essentially make all major decisions (which happen very slowly here...the decision to get a CT scan may take 2-3 days of hemming and hawing and discussion before it gets ordered, and then another 2-3 days to actually get the scan, since our machine is currently broken and we ship patients to a private facility to get the scans...). We do have a great intern (Celia Odometse) who is very motivated, stays late, and in general is on top of things.

Meredith Edwards is a UPenn student who was on our team until today, when she started another rotation in a community hospital. It was a big loss not having her around, since she was so competent and got lots of things done on rounds. But we did get an infusion of Australian medical students to Princess Marina Hospital, and joining our team today was Nadia, a 4th year (out of 5) medical student. I showed her the basics of the hospital and was able to get in some good teaching, reviewing several chest xrays and procedures (blood draws, cannula insertion, paracentesis). She's a good student and I think she'll be able to help out the team since we're so busy.

PMH is overflowing, as usual, and we went into the weekend with 30 patients. We came in this morning to find 27 patients on our census; since there are rarely weekend discharges, I knew this was bad news. 3 patients had died, all with meningitis. Two were RVD (retroviral disease; or HIV) positive patients with presumed cryptococcal meningitis. When Meredith and I did the spinal tap on one of them on Friday, we actually could not measure an opening pressure because the spinal fluid kept rising in the barometer and then eventually overflowed to an undetectably high level. The last guy was a young suddenly ill 35 year old, RVD negative, who had a horrible bacterial meningitis; he died roughly 48 hours after admission to the hospital. We're still waiting on the gram stain/culture from the spinal fluid, but my bet is strep pneumo meningitis because it's actually really common here...we had him on all the right medicines, but I just don't know if we could have saved him.

Hopefully the next few days brings some better news; we did send home a few people today, including one woman who had been in the hospital since September 28th! We're on call again tomorrow, so I think we'll be okay as long as Moolooki doesn't admit another 16 patients...

On a more cheerful note, I walked by the Peds wards looking for Jyo today, and found her hard at work doing a paracentesis and two very difficult cannulations. Her team was post-call, so she held down the fort very nicely. Strong work Jyo!

Madikwe - Tau Lodge

Jyoti and I spent a fabulous weekend at the stunning Tau Lodge at the Madikwe Game Reserve in South Africa. We got T-Man (Luis' Botswanan counterpart, for those Guatemalans who may be perusing this blog) to drive us there and back, with minimal hindrance from Customs (except on the way back...need to remember out address is 154 Pilane Road, not Pilane Court, because apparently that matters...).

We got there early (as recommended) and we had some extra time to hang out and chill at the Lodge before the game drive that evening. We lounged in the sun, and dipped in the pool, but were then driven away from our swimming hole by this creature. Yes, it is bright blue.

I was quickly rinsing off after swimming, when Jyo called me to the window -- about 50 feet away across the pond a thirsty rhino came to bathe in the mud!

We ate lunch (the chef "threw together" a delicious lactovegeterian meal for us after patiently going through all our dietary discretions).

Then we went on the game drive -- huge toyota landcruiser 4x4 that was pretty gnarly. We saw lots of impala, kuru, zebras, red hartbeest, and springbok before we came across this -- a lion having just finished off the last of a zebra. It smelled awful! Apparently he had been eating the zebra meat for 3 days...

Not far from there we were stopped in our tracks by a wildebeast infiltrating a pack of zebras. Apparently if a wildebeast gets left on his own he'll pretend to be a different herd animal to try and stay safe from predators. This close up of a zebra came out well.

And finally, no big game drive would be complete without elephants! We saw a group of 4 elephants, all females of different ages, and 1 male lagging behind (he had been cast out on his own, but still had some separation anxiety...). The matriarch of this group was 35 years old and was leading her group to safety, but not before stopping to sniff the landrover :).

The sunrise and sunset were beautiful, and I'll leave you with one of each. Enjoy!

Mokolodi

After a grueling 2 days of work (surprisingly, work was actually grueling), we decided to join Paul (Brown Med R3 here in similar capacity) for his first (and only) sightseeing in Africa -- theMokolodi Game drive. It's only 15 km away, but it's an expansive (2x5km) game reserve that has protected areas for all its animals. And did we see animals?! Here are some pictures:

Big ol' rhino. Mom is 15 years old, and daughter was born on the reservation, is 5 years old (but ready to have kids of her own...)

Real live wild male giraffe. Nothing like Bo, the uni-gonadal inhabitant of the Franklin Park Zoo in Boston (another story for another day, another time...). But still pretty cool. And really really tall...

Wild Kuru stopping traffic by leaping 6 meters into the air in front of our truck. I got off this picture just in the nick of time. The beast is bigger than a moose! And much faster.

A crazy-eyed spotted hyena trying to figure out a way to eat Jyoti as she takes this picture. Don't worry, I was right behind her in case anything happened... :)

LAST BUT NOT LEAST -- yes, we did. We did pet the cheetah. It purred. That was frickin' awesome.