Category Archives: Awesome

A Day in the Life

The day starts with a cup of instant coffee in the hopes of shaking the feeling of “I shouldn’t have stayed up reading last night but I probably will again tonight.”  Honestly, the coffee should be a decent pot of French pressed African brew, but I have taken to waking up at the last possible moment.  (I used to be better: it was yoga, a Psalm and a proper breakfast; but alas, no more.)   Still, I do not actually wake up until I am driving through the heart of Pretoria threading my Renault between a taxi and a Putco bus.  If Highveld radio is cooperating, they have finished their Jo’burg traffic reports and are pumping LMFAO.  Wiggle, wiggle, wiggle.

My mornings consist of waiting for clients and performing neurological assessments.  The clients are a strange mix, some appearing as if they just came from the farm and others stylishly dressed complete with heels and dangly earrings dangerously within the grasp of a one-year-old.  The babies are equally diverse, if more in demeanour than appearance.  Kids come loaded with a personality at a very young age.  Some babies are scared of everything that isn’t there mother’s boob—It’s a block, kid; I promise it won’t hurt you—and others leap at me and start tearing into the toys.  Block in face, sqeaky-toy down, crayon in mouth, time to jump off the table.  They even respond to the needle-prick differently.  One kid started bawling, waving her hand around and flinging blood everywhere.  I ended up wiping the blood out of her hair with an alcohol swab.  I have baby blood on my hands.  Another little girl cried for the entire assessment until I stuck her finger; then she was calm and cool.

On a good day, I finish with my assessments by one.  Then it is lunch in Kalafong’s Klinikala courtyard, the patient-free safe-haven of Pretorian medical students.  Lunch is, occasionally, surprisingly tasty.  Though, perhaps three months of my own subpar cooking have lowered my standards.   South African medical students are on summer break now, so lunch is usually accompanied some reading of a decidedly non-medical sort.  Why read yet another article about HIV-associated whatever, when you could read about futuristic California, ancient Chinese military history, or, well, anything else.

I pass the afternoons with data entry and reading those neglected articles on HIV-associated whatever.  The Fugees and Thelonius Monk make this ritual bearable.   I am home between four and five, after round two of death-defying feats of automobile aggression.  Only driving in Boston is more fun than this.

Then, there is usually a run, the above-mentioned subpar cooking, a Black Label or Windhoek and, finally, recording a few of the day’s events in Afrikaans.  Ek wil baie ‘n Boston bier kry, maar ek kan nie.  Jammer.  Some nights I get to rock climb, and, like I said, I used to do yoga.  Other nights I hang around the district hospital emergency department, sifting through charts for lacerations and deftly avoiding cases of full-body pain and epilepsy.  Those nights are fun, if exhausting.  The casualty ward is one of the places in South Africa where race is moot, at least among the staff.  Besides, every now and then a Mozambican finds his way in and I get to butcher yet another language, whilst sewing a bloody hand.  My suturing, thankfully, is far superior to my foreign language abilities.

Later, if the mosquitoes stay away from my ears, I sleep like a baby, and dream about babies, and wake up to more babies.


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Playing with Babies and Calling it Research

“Count something.”
  -Atul Gawande

In a previous post, I criticized the emphasis of HIV research, citing the enormous amount of money spent testing novel interventions that are unlikely to change the course of the epidemic.  In this post, I think it is requisite that I take the other position.  To be clear, I am not writing this repentant post in order to be “fair”.  (My Irish mother took care to inform me that life is not fair.)  This post is also not for the sake of making my own argument stronger.  Rather, I feel a burden because my own research project is not directly saving lives.  More importantly, on principle, every effort to make observations about our world is intrinsically valuable.  All of science hinges on that idea.

Taking solace therein, I will confess that my sole job is to count things.  Babies, to be exact.  To be more exact, I count the neurological development of infants.  When the study is over, I will have assessed 200 infants in an attempt to quantify the effect of in utero HIV exposure on their development.

Today I counted the mental abilities of four babies.  With each of them, I spent about 45 minutes handing them toys and puzzles and recording their responses.  I make them all ring a bell, then stack blocks, and then, for a grand finale of mental achievement, I have them put the square peg in the square hole and the round peg in the round hole.  Altogether, I spent a grand total of three hours playing with babies.

That is correct, I spent most of my workday playing with babies.  I will do the same tomorrow, and again the next day, until the requisite 200 babies have been played with and assessed. Then, I get to publish a scientific paper all about playing with babies.  I get to list “Baby Playing” on my curriculum vitae.  (If all you had listed on your CV were Founder and CEO of Facebook, or some other inanity, I would understand your jealousy.) When some residency director asks me what I did on my research fellowship, I get to grin and say, “Sir, I played with babies for an entire year.”  What did you do on your research fellowship?

What is more, I am actually getting paid for playing with the babies.  Why is someone paying me to pad my resume with toddler time?  Setting jest aside momentarily, our research group is testing a theory regarding HIV-exposed, but uninfected infants.  I wrote a recent post in order to introduce briefly the idea of HEU populations.  These kids are my babies.  Our hypothesis is that being born to an HIV-positive woman will delay neurological development by a measurable amount, even though the affected baby is HIV negative.  In order to put that theory to the test, we are using a scale that was developed about 50 years ago by psychologist Nancy Bayley.  The scale consists of a series of games and toys and puzzles that the infants have to solve.  The bell I mentioned above is a good example. Does a child ring the bell, explore it, or simply put it in her mouth?  Is a child at a level mentally where she can put the circle piece in the circle hole?  Do social cues and phrases make sense to a child?  (Click here to watch an example of the test.)

So, now I ought to humble myself (surely a rare occurrence).  The CAPRISA researchers I criticized are identifying new ways to curb the HIV epidemic.  If their product does not work well, they will likely come up with something else.  I, however, am playing with babies and calling it research.  Notwithstanding our research question is new and unanswered, I am merely counting things, observing the effects of natural phenomena.  I may as well take a nap under a tree and wait for an apple to fall on my head.  Or rather, I should take a long, bird watching walk on a deserted, South American beach.  Such is the difficult life of a researcher.

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Snowflake: Emphasis on Flake.

Surviving Africa one hot, precarious day at a time.

So, this car is awesome.  It’s previous owners, not-so-awesome.  I will save for another day the saga of the trolls who sold me this car and the usurious ogres who are making a living shuffling my money over the Atlantic.  For now, enjoy a picture of the trusty steed (she’s white, like Shadowfax!) who mightily carries me to and from work.

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Team America: We’re Number Three!

The Americans I met at the climbing gym last week organized a trip to Roc Rally in Boven.  It’s a big climbing competition, hosted at Waterval Boven, in Mpumalanga Province.  The climbing area has over 700 bolted routes.  It was gorgeous; and the climbing was amazing.

The event received a lot of talk among my South African and American climbing friends who went last year.  I expected the Woodstock of climbing.  But, while there were some interesting and unwashed characters, it was actually pretty mellow.  The climbing community, both in the US and in SA, is a very welcoming group.  Almost everyone is happy to share their knowledge and gear.   I enjoyed the atmosphere.

Friday was a day of firsts for me.  A group of us took Friday off from work and left Pretoria around 6:30, getting us to Boven three hours later, in time for a full day of climbing.  I decided I wanted to lead climb a grade 15 route, which is relatively easy in the grand scheme of things, but would be a bit of a challenge for me.  I was then going to clean the route.  I had never led or cleaned a route before.

So, “Chick’s for Free,” as the route is named, was a bit of a struggle at the crux.  I froze up several times and stared down at the last bolt thinking, “This is going to suck when I fall.”    But, I didn’t fall, I didn’t rest on the rope, my belayer helped me only with encouragement and ideas.  Then I cleaned the route.  And this was all before the competition began.

That afternoon, one of the diplomats decided she wanted to compete.  I was without a climbing partner and so Team America was born, with much Texan accentuating.  We briefly toyed with the idea of hollering, “F— yeah!” from the top of every completed route, but decided against it when we saw 12-year-olds climbing the same routes as us, and climbing them better.  It’s best not to share too much of American culture with impressionable South African youths.
The Rally started that night with a night climb.  That’s right, rock climbing in the dark, by headlamp.  Brilliant idea, huh?  But, Team America got points for it.  And that’s what’s important.
The next morning started with aseiling.  Again, hurling myself off the top of a cliff with twenty pounds of gear on my back is not something that had occurred to me before that moment.  Anyway, we climbed four routes that morning, ending the morning with a personal best for both of us, a grade 16.   The afternoon slowed us down.  We had trouble finding the next route we wanted to do.  By the time we did, we were both mentally and physically exhausted.  We called it quits on an easy one, not wanting to make mistakes, especially with regards to safety.  Besides, this is all for fun, right?  No, that’s what Team Russia says when they lose in rugby.  Burn.

Team America took third in mixed team competition (largely due to our amazing handicap).  We took home some cool climbing gear.  However, despite receiving an award for mixed male-female team, the organizers decided to award us with two women’s, fleece, v-neck vests.  The one for me was colored “Bright Peach.”  Team South Africa strikes back.  Touché.

For the climbing uninitiated.  Grading: Climbing grading systems never make sense to me.  The South African grading system starts at 5 and goes to 36.  I guess it dates back to when mountaineering, hiking and rock climbing were all the same sport.  One through 4 were a walk in the woods up to a scramble.  Actual rock climbing thus starts at 5.  A grade 36 is only accomplished with suction cups attached to your hands.  The American and French systems make even less sense.

Aseiling is literally hurling yourself off the top of a cliff.  You belay yourself as you rappel down the face.  “Don’t worry,” they told me, “Jumping off the top is the worst part.”  Oh.  Really.

Lead climbing:  How to scare yourself.  This is when the climber clips in his own rope as he ascends.  This means that you can be as much as 2 or 3 meters about your last clip point, potentially allowing you to fall twice that distance.  It’s safe, but scary.

Cleaning is taking all the equipment down when the group has finished climbing a certain route.  It involves untying and retying yourself at the top of the route while dangling from the chains.


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On Call at the Fong.

Monday night I took call in the labour ward at Kalafong Hospital.  Our little baby factory produced 28 new lives that night, mostly under the competent and cruel oversight of the “Sisters,” the local nursing staff.  The med students and residents were entertained by controlling pre-eclampsia, dashing blood down to the lab and trotting off to the theatre every now and then to cut out a baby.

A little background.  Kalafong—affectionately known as K-fong, the Fong, the Schlong—is a large public hospital in Pretoria West, a former township on the outskirts of Pretoria.  It functions like Charity or Grady, except the nurses are meaner and less helpful, the med students draw blood and there are no attendings to be found anywhere, ever, especially not at night.

The experience was amazing.  Both the residents and the students were very competent and very helpful (it has been almost a year since I did my obstetrics and gynaecology rotation).  I tried my inept hand at both drawing blood and starting IVs.  Neither are easy tasks on oedematous, pre-eclampsic women.  But, most of the medical students here are masters.  Plus, just like in the US: call = bonding.  Overall, I loved it and I will be back soon.

Post-script.  You will have to forgive the strange spellings of certain words.  I am writing on a South African word processor.  U’s and O’s go where they shouldn’t; R’s and E’s are backwards; and everybody drives on the wrong side of the road.

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A Pretoria Spring: My Lips Hurt Real Bad.

The morning air here is delicious, if lip-chapping-ly dry.  It’s beautiful.  Monday, I made my first trip to Kalafong Hospital where the wards are made up of a series of separate buildings, so that you are always walking outside under a shade of some covered walkway or tree.  Right now, it is quite a pleasant to work.

So, news!  I have a car!  It was a mix of fun and frustration dealing with the droves of car dealers.  Used car salesmen, it seems, have the same reputation here as they have in the states.  They lived up to their name.  Anyway, I walked away with a 2000 white VW Chico.  I think she will do the trick on Pretoria’s mountain with minimal pushing.  Perhaps I will name her Chica.  Chica the Chico?!  Ah, that would be one gender-confused car.  The Norwegians want to name it Snowflake, but that has already been vetoed by one level-headed American.  Besides, a beastly machine like the Chico cannot be called Snowflake.  (Pictures to come soon)  So, leave your suggestion for the name of my car in the comment box!

In other news, the jetlag is slowly wearing off.  My Norwegian dorm-mates cannot get enough of lying in the sun (go figure).  It turns out that I did, in fact, learn something during my OB/GYN rotation.  My bags only got delayed one day on British Airways.  And, the Springboks play this weekend and USA Rugby plays next week sometime.  I think this is the USA’s year in rugby!  (I’m from Boston; we’re used to vain hopes.)

Don’t forget to suggest a car name in the comment box below!

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NYC Part One: The Spirit of Zingerman’s

Block M on the menu, spelling “Michigan Sandwiches!”  Maize and Blue in the heart of Chelsea!  UMich is taking over!  (And with a new football coach and one of their better recruiting classes, they may actually win a few games this season…)

This is Grey Dog, at 242 W 16th Street, in Manhattan’s Chelsea neighborhood.  On top of the typical (albeit strange) accoutrements of a largely gay neighborhood, Chelsea has beautiful brownstone buildings and seriously good food.  This place surprised me, most of all by the Block M on their menu.  I asked the girl at the counter “What the –?”  I was told that one of the owners was trying to emulate Zingerman’s.  If you don’t know, Zingerman’s is the best deli in the world, ever.  It is located in Ann Arbor, MI, not far from the University of Michigan campus.  So, the UMich connection to Manhattan is obvious, right?

I met old friends Trevor and Erica and Erica’s med student boy toy (we should all be so lucky!), Craig, for lunch. It didn’t quite live up for my Zingerman’s memories, but it was a pleasant surprise.  Especially since my family bleeds Maize and Blue!

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