Friday, September 14, 2007

In The Beginning


Greetings and salutations. Welcome to the beginning of (and longest entry to) my internet journal of my travels in Africa with the Baylor International Pediatric AIDS Initiative (BIPAI), as part of the Pediatric AIDS Corps (PAC). I am currently a few thousand feet in the air, above what is either Botswana or northern South Africa. We’re too far up, so while I can see the browns and greys of an arid landscape below, I have to squint my eyes and fire up my imagination to see the herds of cape buffalo and zebra. My long time friend Anu Agrawal, who I’ve known since medical school and has recently graduated from the Children’s Hospital of Oakland pediatrics residency and joined the PAC, is sitting a few rows ahead of me, possibly reading, sleeping, or watching the Disney cartoons that are showing on the plane’s teleprompters (the sun has just risen on the 2nd of two red eye flights we’ve taken in the last 40 hrs). We’re nearing the end of a long trip that started in the morning of 8/12/04.

Graduation and travel home
To take a few steps farther back, I graduated from family medicine residency on July 1st, with a beautiful ceremony at the Trentadue winery in northern California, attended by the Pierce clan. After packing up and saying goodbye with a heavy heart to my friends, the Russian River Brewery, and the hot tub, my brother David and I squeezed into the Element (The Toaster) and made a 3 day journey to Texas. With scenic views, including Route 66 and the Grand Canyon, we made it home without any mishaps (and somehow still as friends). After a week in Corpus Christi, catching up with my family, I packed up again and drove to Houston to begin the PAC pre-service training.

The PAC is composed of about 50 doctors, mostly pediatricians, but also including medicine/pediatric doctors, family doctors and and a few internists. Many of us have just graduated from residency, a few have recently completed fellowships in hematology/oncology, cardiology, or masters of public health, and some have been out in practice for a number of years. The PAC’s mission is to provide quality, compassionate care to children and their families affected by HIV/AIDS in Africa. It begun only last year, as a way to staff the clinics that have been built through BIPAI in the African countries of Botswana, Lesotho, Swaziland, Malawi, Burkina Faso, Uganda, Tanzania, and most recently Kenya (I have a feeling that sites on the horizon are Namibia and Mozambique). Funding for the clinics and for the PAC is through a combination of contributions from the local African governments, Baylor College of Medicine (BCM), and the philanthropic branch of Bristol-Meyers Squibb, among others. Of the 52 docs that were placed on the ground last year, around 30 are staying for a second year and that means there are around 20-24 of us newly assigned PAC docs this year.

Wednesday, August 15, 2007

I’ve now safely arrived in Maseru, the capital of Lesotho, and am writing on my laptop in bed while accessing the wireless internet from the clinic across the yard. Before elaborating on that, I’ll catch up a little on how I got here.

The training in Houston, which began 2 weeks after residency graduation, went well. They put the 2 dozen of us up in the relatively fancy Marriott Resident Inn in downtown Houston. Ahh, Houston. I had forgotten all the wonderful things it boasts: barbeque, roaches the size of small mangoes, 100% humidity, 90 degree weather, aggressive homeless folks, traffic, hmmm, what am I leaving out? OK, to be honest, I loved getting back to my favorite haunts – the Gingerman (great bar) and Rice Village, Istanbul Grill, Balaji Bhavan (south Indian cuisine) and seeing some old friends. The first weekend brought my family medicine boards (2 more weeks till I get my results...). Monday through Friday we sat in lecture, mostly covering HIV, TB, and tropical disease. We worked in small groups on case assignments, did a little lab time, and filled out a ton of paperwork necessary for working and living abroad (taxes, insurance, shipping, loan repayment, canceling your cell phone, arrangements with your bank and car insurance, etc). It’s amazing how much stuff is involved. The prime minister of Lesotho dropped by Houston on his way from speaking with Bush about HIV in Lesotho. We had a fancy lunch with him, part of his cabinet, and lots of serious looking buff guys in suits with ear pieces. I got to speak briefly before him and the delegation about how excited we all were to get started in Africa. The local NPR was there and did a little story on it. (
The PAC group looks great – compassionate, funny, talented people. I feel very lucky to have the chance to work with them. We bonded quite well during our time in Houston. While we were excited to head off to our respective sites in Africa, it was hard saying good-bye to those that will be many miles away in other sites. We met two other docs that were doing the training with us but that weren’t going to Africa through BIPAI. Katy, a long time pediatric ER physician, has worked for Doctors Without Borders for many years. The other, Jen, has been out of pediatrics residency for only a year but is traveling though Physicians for Peace to Eritrea (near Ethiopia) to help start the country’s very first pediatrics residency.

I drove back to Corpus for two last nights with the family. They saw me off at Corpus’ little airport, where I flew to Houston and met up with Anu. We took the 10 hour flight to Frankfurt, Germany, where the men are tall and the women are taller. Wow, there is a plethora of attractive, beer guzzling women that would make quick work of me if I cut in front of them at the line to the bar. One of my first sights at the Frankfurt airport was a large group of Orthodox Jews in full regalia, bobbing while praying and facing one of the walls in the terminal. It took me a second, but I realized how wonderful it was to experience what was impossible to see only 60 years ago.

Maseru, Lesotho
So since most people will have given up reading by this point, I will keep this short for you die-hards. We arrived in Johannesburg (Joburg, as is hip to say; you’ll look, sort of, like a local, if you do this) without trouble and rushed through customs, grabbing my baggage and getting into the tiny terminal for those going to Lesotho. This plane was a little puddle jumper, room for about 30-40 small legged people and one short (required) stewardess. We stepped out of the plane around noon and were greeted with amazing, very non-Houston like weather – mid 50s, sunny, clear and crisp. The landscape is gorgeous, like a mixture of Joshua Tree National Park, Arizona and New Mexico. We’re in the end of winter here, with most days in the 50s and nights in the 30s (tonight the expected low is 18F). One PAC guy that’s been here a year complained to us that it wasn’t overcast and rainy enough for him. After wintering in Santa Rosa, I’m ready for some dry winter days. We were greeted by Dr. Edith Mohapi, the clinic director whose husband is the Minister of Finance (nice people to have in your cell phone for emergencies). Driving on the left side of the street in a car with the steering wheel on the right (wrong) side and the shift on the left (wrong) side is a little weird, but I think I’ll get used to it. We’re temporarily staying in the “cottage”, the living quarters built on the clinic campus for visiting docs and med students. Cindy, Kevin, Dewey and any others who had the pleasure of staying at the Casitas Verdes at the Hospitalito Atitlan in Guate will see no relationship between them. Steaming hot water shower, fridge, washer/dryer, wireless internet, and a distinct absence of scorpions are some of the stark differences. Man, am I in Africa?

I already miss you guys very much. I do hope that I can convince someone to come out this year, though I know how busy it is, whether working the daily grind or getting through residency. It looks like I can entertain visitors whenever I want; clinic is M-F, mostly in town but some work in the rural parts of the country, some traveling for teaching seminars and meetings, and 4 weeks of vacation. Additionally, I’ve already started snooping around to see about elective opportunities. According to BIPAI central, most months for the coming year are filled for all PAC countries, but our clinic director says there's probably extra room for those interested. There is a government hospital in town that people occasionally rotate through, though Dr. Mohapi says that it’s understaffed, undersupplied, and you might be asked to do things out of your normal scope of practice. Don’t worry, Jim, I told her right away that I knew a few people that might find that somewhat entertaining. Luckily, there are better ways to get here. There is a direct flight from D.C to Joberg, then it’s just the 1 hr flight to Maseru. I’ll let you guys know more about working here after I actually start to do some myself.

OK, I’m out. Take care. Jake, do me a favor and say hi to the ladies in the clinic (Eugenia would never forgive me if I didn’t).


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