Its been a a while

Two weeks ago Lynne and I finally took a break and went to an animal reserve south of here, just over the SA border, to a game lodge called Tau ("lion"). It turned out to be one of those all inclusive resorts where you are greeted at the front door and your car is driven away as you settle into a routine of being pampered, not unlike what I imagine a cruise would be, with too much food, drink and the like. We skipped a meal and were called by the desk to check on us! The game drives were amazing with all the usual just not in abundance as the late rains had made it less easy to access the water holes and areas where some of the popular game congregate. It was very relaxing and long overdue.

That Monday I was on the road with two med students, Kandace from UPenn in her fourth year and Kea, a Motswana, schooling in Australia, in her last year. We headed out to Tsabong in the SW of the western frontier to a primary hospital there. I no sooner got out of the car than I assisted the CMO with a C/Section ( a "Cesar" as it is known throughout the area). We discussed the numerous ways to perform this procedure and the benefits of each as we saw them. We then rounded in the small general purpose ward and the next day I taught a class on CHF and HIV. It amazed me that HIV has such a presence even at the "end of the road". All you need is a trucking industry that is "serviced" as it were and spread of STDs is assured.

Tuesday we headed back east then north then west again to Hukuntsi where we met the new CMO, rounded, taught, learned, laughed. We stayed there for two nights, me in a suite with two other guys that enjoyed ladies of the night well into the morning so sleep was with medical aid and ear plugs crammed deep into my EACs. Doubt "protection" was high on the agenda as it was all very alcohol fueled.

Thursday we again headed east, north, then northwest to Ghanzi for five nights. We worked with the local district hospital team on the inpatient services, then in the clinics of Ghanzi with the only MO for the district.

Saturday night we went to a village, D'Kar, about 45km to the east and witnessed a "healing dance" by the San, an ancient ethnicity of the area who use some 20 different clicks in their language. It is impossible to comprehend and I found myself staring into their mouths as they discussed the day, much to their amusement and glee. On the way out we stopped off the road and witnessed what I hadn't seen since Afghanistan, a Milky Way so huge and bright that you could read by it!

There is a school in the same town that houses San kids as they live very remotely. They are a group of people that are very small featured, almost orange in color, broad open faces, always laughing.

I saw the worst case of AIDS I have seen thus far; a 23 yr old woman with wasting, advanced TB, genital condyloma, Kaposi's sarcoma, and a huge fist sized, pendulous, papilloma of the vulva. One of my lasting memories of the hospital will be Kandace and Kea, both of whom thought they might go into a more tertiary specialty, sitting on the floor in peds laughing and giggling with the kids there, then telling me that they just might go into primary care. Nothing like a 9 day adventure into key primary care areas to open one's mind. That and some giggling kids in a peds ward in the middle of nowhere.

Sunday we went to my new favorite town, Charles Hill on the Namibian border, and saw the local and lonely doc there. My lasting memory of the trip will be sitting in the bed of the small pickup truck we were driving, sipping a Coke of all things, taking in the surrounding culture of the town center as Herero women walked around with their characteristic headdress, kids laughed and played, and the rival political parties blared sound trucks at each other across the dusty expanse. Man was that cool or what?

We drove home on Tuesday and spent the rest of the week in the usual outreach routine. Now it appears that the students from Penn might get to spend their time in Mochudi, a huge benefit for them as the experience becomes more truly "global", integrative, and assimilating.

See those of you in the PDT time zone in less than a week!