Wow, finally!

Finally, A New Blog Entry!

It’s hard to believe it’s been months since I’ve updated the blog. I’m not sure why it’s taken so long. The work here in Lesotho has become a little more involving, and in addition we seem to be traveling every weekend. I’m not complaining. It keeps us out of trouble, I’m sure. The good news is that we now have high speed internet at the house, so I should get a little better at keeping you informed (I know you’ve been on the edge of your seats). Included in this blog entry are more details and pictures from the outreach work in Mokhotlong, an HIV testing event, weekend trips to South Africa, and my vacation to India.

Second Trip To Mokhotlong
October 21 – October 26

This time the scenic trip up into the Maloti mountains was undertaken by a group of four: Paola Peacock-Villada (Clinton Foundation), Tony Garcia-Prats and Heather Draper (Baylor), and myself. The Clinton Foundation works internationally to obtain more affordable prices for HIV meds and testing supplies. Some of Paola’s work has included increasing testing of HIV positive children under 18 months with the DNA PCR method, improving access to care, insuring good follow up after diagnosis is made, and helping to streamline the labs across the country so that crucial lab monitoring is available. The PAC doctor’s work would be impossible without the hard work put in by the Clinton Foundation.

Again as we headed up the mountains we were greeted by heavy clouds, though this time they only released a light drizzle instead of hail. Though later we rounded a bend and were awed by an expanse of freshly fallen snow! Snow in Africa as spring turns into summer. Amazing.

At the end of that first Monday, I felt like I was already getting more done than my first time in Mokhotlong. I spent more time working with the nurses of the maternal child health clinic and the maternity (labor and delivery) ward. Regardless of overtime or effort, nurses at this hospital earn next to nothing (yes, even Sutter Santa Rosa pays more). There are 5 maternity nurses, one on overnight at a time, pulling 12 hour shifts. There are over 100 deliveries a month, and the nurses, who are all trained as midwives, do just about all of the vaginal deliveries. For the most part during the night shift, the physician on call is just called to perform cesarean sections [and they aren’t even obstetricians…shocking! (said with sarcasm)]. The physicians still write the orders (like inducing with 50 mcg of misoprostol; they only have the 200 mcg tablets so they can only break them down to quarters; though it’s better now…most of their inductions were failing possibly due to expired Cytotec), perform the ultrasounds (I was teaching them how to do 3rd trimester biometrics – measuring various fetal parts to help determine how far along the pregnancy is; thank you Tom Neal), and of course perform operations like tubal ligations, etc. I have heard conflicting information about pregnancy terminations. A doctor in Maseru told me it is a legal procedure, and she does them at her private clinic for roughly $200 dollars (remember that the average income is less than 2 dollars a day here). One of the Zimbabwean docs working in Mokhotlong says he was told that it was illegal (women have been brought to the clinic by police after having an abortion), and it seems no one in this expansive district performs them. Some women go across the border to South Africa to obtain the procedure. I haven’t seen any septic abortions come through the maternity ward, but with access as limited as it is, I won’t be surprised when I do.

One morning I walked onto an interesting scene. I found a lone nurse in the delivery room scrambling to get oxygen and suction started for the struggling baby she just delivered. I took over the resuscitation, while the same nurse returned to the new mom who was lying naked on a rubber sheet that covered a foam “mattress”. Not changing gloves, she took out the needle and thread and started repairing a 2nd degree laceration. She was a little flustered when, wide-eyed and open-mouthed, I asked her if they always did the repairs without local anesthetic. She shuffled around the room looking for lidocaine, found it, then went back to the repair (same gloves on) without using it. Wow, that patient was sooo stoic; she just made faces and a few quiet grunts. Amazing. I didn’t like it; but amazing none the less. Following the repair, the patient put on her dress, picked up the baby, and walked out of the delivery room and over to the communal post partum room. I’m not sure, but I don’t think she had a birth plan.

Soccer with the princes

The PAC docs and the clinic staff helped test and screen kids at an awesome HIV testing event/soccer tournament in Mohale’s Hoek, Lesotho, organized by our friends David, Pete, and Paola. Prince Harry of England and Prince Seeiso of Lesotho, whose charity organization Sentebale (meaning “Forget-Me-Not”) was involved, popped by in their helicopter to watch HIV education and testing practices. See attached pic of the prince with Baylor docs Kathy Ferrer and Edith Mohapi, as well as Paola and Pete. Check out the Sentebale website for more info: http://www.sentebale.org/home/index.html


Arrival of the visiting scholars

I was very happy to see my old UT Pan Am alum and friend Yvette Almendarez and her pediatric colleague Ashley Cox arrive safely in Lesotho. They are both Baylor Med School grads and are in their final year of pediatric residency at Texas Children’s Hospital in Houston. They came to learn a little more about pediatric HIV, help us in the clinic, and see the sights of southern Africa. Mostly they just called John to fix their plumbing and fight off squirrels in the attic at 3 in the morning. But that’s too long of a story for now. We took another day trip to Clarens, the quaint town in South Africa that has good cheese and beer on tap. Sounds strange to travel to another country for cheese and beer, huh? Well, not if you know me. This picture is us in our car on top of a moving tow truck. Read on for more details. Yvette and Ashley are back in Houston now. Thanks for coming guys and good luck; we miss you.

3rd trip to Mokhotlong

Following an interim “routine” week seeing patients in Maseru, I made the trip out to the mountains again, for the first time going it alone. It was slightly romantic, being the lone doc in his 4x4, slowing winding his way up the mountain roads between remote villages, greeting sheep herders and dodging sheep dung. This picture was taken on the way back from Linakaneng. The animal is an nku (sheep; maker of sheep dung). Along with the African docs assigned to Mokhotlong city, I saw children in the children’s medical ward (CMW), adult inpatients, and patients at the dedicated Lerato (meaning “love” in Sesotho) HIV clinic. This is the clinic that is a smidge bigger than a closet, but with fewer resources. I drove out to the rural health centers of Libibing, Linakaneng, Malefiloane and Mapholaneng. The roads are unpaved and super rocky, but wind through gorgeous terrain – one of the best commutes in the world. There is always plenty of variety in the conditions the people have to face (usually more advanced in their course and always with fewer resources available to diagnose and treat them). To name a few, I saw 2 likely new cases of lupus, gestational hypertension, a kid with total body swelling due either to malnutrition or kidney disease, active tuberculosis (so common that it’s routine), and conditions associated with the weakened immune system caused by HIV infection. Every day is different, offering the chance to work in the hospital and outpatient setting, do home visits, deliver lectures, mentor nurses and docs, and perform tough blood draws (including external jugular and femoral vein blood draws on infants).

Reunion in Joberg

Thanks to the planning and hard work of Seema, the medicine/pediatric PAC physician – gourmet chef – vacation planner extraordinaire working with us in Maseru, several of the PAC docs from around southern Africa got together to enjoy museums, food, caipirinhas, dancing, and the occasional irritant gas bomb (random). As Yvette and Ashley will attest (they will, just ask them), the trip from Maseru to Joberg was a bit hectic. While driving the car on the highway Anu realized that the clutch pedal stopped working, and he could no longer change gears. While theoretically we could have completed the remaining 3 hours to Joberg in 5th gear, it was his better judgment that had him pull off to the side of the road. Thanks to our South African car insurance, we were quickly towed to a “24 hour station” manned by some of the toughest looking men (and women) of the Free State (the name of the South African state in which we were stranded). I wish I had a picture, but the leader, a huge Afrikaans guy, had the most impressive mullet I’ve seen in Africa. They were great, and actually worked on the car for about an hour on a Friday at 8pm, eventually replacing a broken seal and getting us on the road (for an amazing $70 US) in time to meet the rest of the group for dinner in the Melville district of Joberg. The picture is not actually of the garage crew but two sexy hunk Botswanan PAC docs - Jonathan Bernheimer and Paul Mullen.


Two weeks in India

I had the pleasure of joining Anu and his parents on a whirlwind trip of southern India. Anu and I flew via Emirates Airlines, leaving on a red-eye from Joberg to Dubai, the capital of the United Arab Emirates (I actually remember learning about that country in Mrs. Putman’s 6th grade Social Studies class) and on to Mumbai (which is not, strangely, the sister city of Dubai, but did used to be called Bombay) on the west coast of India. Anu’s family was truly wonderful, treating me like part of the family from my first moments in the country. This was my first trip to India, and was it ever much anticipated. Since going to med school, where 80% of my friends were 2nd generation Indian-Americans (not to be confused with American Indians, Native Americans…or Pakistanis), I have been in love with what I have learned of the culture. The colorful and flowing saris, the permeating presence of Hinduism, Christianity and Islam, the music, and the food (ahhh, the food) were richer than I had anticipated. I was impressed with how much more crowded it is compared to Africa, especially Lesotho (I imagine much of Nigeria might be more similar to India in this respect). There is little possibility to get away from honking horns, city lights, and jostling crowds – even in the relatively less populated south where we were traveling. Anu’s parents, originally from India and currently living in Midland, TX, set a busy but enjoyable pace. We took several night trains, and I experienced first hand the difficulty of voiding on a bumping Indian train. I also saw more rats (Anu insisted they were just mice) among the tracks one night than I might have seen in all my life. Just imagine that scene from “Indian Jones And The Last Crusade”, then imagine world peace. Well, why not, you were already imagining, weren’t you? We traveled through 6 states: Maharashtra, Goa, Karnataka, Kerala, Tamil Nadu and Andhra Pradesh, went to a family wedding at the Tirupati temple (so much gold and sooo crowded), hung out at a hill station in Coonoor, and motored and slept on a house boat in Kochi. By far the most amazing experiences were the meals. I had so much masala dosa,
idli, vada, chapatti, sweet lassi...and thank goodness, never got sick...as far as I know. Well, I guess maybe a course of mebendazole before things “mature” might be a safe strategy.

Dubai

On the way back we spent a day and night in Dubai. Besides a few sneaky merchants and a sketch hotel, it was a great experience. I loved: the savory hummus, extra helpings of falafel, a coast with a warm breeze reminiscent of Corpus, hanging and speaking Spanish with a Colombian back packer, eating Dunkin Donuts, seeing a Hardees, and gazing at a beautifully lit mosque at night.








Back To Africa
Since coming back from vacation things have been moving fast. I’ve been back to Mokhotlong (check out the pics of A Tale of Two Cellulitis Cases: two women in red dresses in two different cities presenting within a week of each other with right hand cellulitis; the child in the picture has typical lesions of scabies), where I continue the tradition of transporting more people with active pulmonary TB in the back of the Land Cruiser. I stayed at the Louis Gregory Center this time - a farm in a gorgeous valley (pic of the house included). I’ve been traveling on the weekends, and the clinic schedule during the week in Maseru is getting busier (we saw about 155 patients today in clinic). I’m hoping things will slow down a bit during Christmas. I’m having a little difficulty feeling the holiday spirit during the summer in a country that doesn’t really deck the halls. I’ve certainly felt more homesick around the holidays, as Thanksgiving and Christmas are celebrated in full regalia by the Pierce clan. Similar to last year, where during residency I had the good luck of being on inpatient medicine call (albeit with some awesome fellow residents) for Christmas Eve and New Year’s Eve, I’ll be the PAC doc assigned to the Children’s Medical Ward at Queen Elizabeth 2 (QE2) hospital. While being around kiddos during the holidays is usually a welcome opportunity, unfortunately it seems half or more of the kids we admit to QE2 die during hospitalization. Infant and child death is so common here. This specific contrast between here and the States will always simply blow me away. The death toll certainly wears on you, whether you’re a visitor or a local (a South African nurse’s child told her, “you don’t smile any more”). But every day that we see a baby or her mom die of malnutrition or TB, we see a hundred more that are healthy, running around, gaining weight, and smiling thanks to the medicines and the people that we work with. I am so grateful to have this opportunity and continue to realize that I get more out of it than I contribute.

Miss you all very much,