Thoughts on Research: All Doctors Are Religious

Anyone can be a researcher!   If you would like to join the self-indulgent world of research, start by learning how to write a scientific paper.  Care of Matt Schultz.

I recently attended the Annual Workshop of Advanced Clinical Care in Durban.  I realized – again – how religious physicians can be.  The conference opened with the typical call to arms that normally surrounds the AIDS “crisis.”  The charge was aimed at the audience of clinical providers present.  The front line physicians were told that all of the tools needed to curb the spread of HIV were available to them, and they must only wield them effectively to win the battle.  Susan Sontag would be horrified.

It is, in fact, far easier to eradicate HIV than I ever thought.  South African doctors must only work harder, then the disease will go away.  No, South African doctors only need to improve their clinical abilities when dealing with HIV-positive patients, then the disease will go away.

My sarcasm stems from a simple observation: the average South African doctor is extremely well trained, especially with respect to HIV.  From my outside perspective, South African general practitioners routinely perform the tasks usually reserved, in the US, for infectious disease specialists.  Is it fair, then, to say to this group of physicians, “You must work harder; you must get smarter”?

But that is exactly what was said.  And, the major problem is that there are essentially only two paradigms with which to deal with HIV: Treatment (but not cure) and prevention.  The former hinges on provision of HIV medications; and the latter is almost synonymous with modifying people’s behavior.

The news of the day was of the latter category: tenofovir gel.  It is an antiretroviral drug that has been formulated into a gel and can be applied in a woman’s vagina before intercourse.  A recent paper claimed a 40% decrease in HIV infection when this gel was used.  There was much anticipation to hear the head investigator speak and much excitement about her findings.  The major benefit is that it empowers women to control their own sexual health, without having to negotiate with their partner about condom use.  It makes slightly less hazardous the dangerous sexual situations into which some women are routinely forced.

I found myself thinking rather negatively throughout the entire conference.  There is, to me, nothing new here.  What we now have is another preventative strategy that works marginally well with intensive education and follow-up.  Even under the idealized conditions of the study, it was difficult to get women to use their product.

The most interesting talks at the conference, however, were by Steven Deeks from UCSF.  He concisely summed an enormous amount of information and then launched into something completely different.  What of the underlying pathogenesis of HIV?  Is there some unexploited fault in the virus’ almost perfect reproductive ability?  And, more broadly, how does our new knowledge of the immune system affect our understanding of other diseases?

In my opinion, that direction is where HIV research needs to go.  What is truly unknown?  Why publish a new edition of the tried-and-failing textbook we have written for the last 30 years?  The epidemic in South Africa appears to have leveled only because the same number are being infected as are dying.  It isn’t working.

And yet, the group of us in HIV research religiously hold to the idea that if we work harder or execute better, we will ultimately win the day.

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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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Sailing, Take Two

I recently joined Tom Vander Salm, his crew Peter and a friend of Dr. Tom’s for a Sunday sail. It was a gorgeous day, with plenty of sun and wind. We hit one squall during which we were happily moored, eating lunch below deck. We also enjoyed a good laugh over the Sunday-afternoon-in-August comedy of errors that keeps the Coast Guard busy with inexperienced, cocky boaters.

This is the link to Tom Vander Salm’s blog, which has footage of Whisper sailing taken by his kite-camera. It was taken during our return from Halifax, Nova Scotia. Unfortunately, on its most recent voyage, Whisper’s kite hit the water and tore off the line. So, the camera, along with some spectacular footage, is somewhere on the bottom of the Atlantic. (It’s probably within a 50-mile radius of Marblehead, so if you felt inclined to go find it, Dr. Tom would be very appreciative!)

Stay tuned for tales from NYC and A Tour of the Promised Land: Hiking in New England!

Happy sails!

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