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Hello....a few updates for you!

1) We have been very busy with the research project. Research in a developing country is a unique experience- most steps take much longer than in the states, but T.I.A. (this is africa). It seems that we are continually working on the project with half a result to show for it by the end of the day: getting approval or access to vital items, getting patient charts pulled, etc. It all takes more time than we were expecting. I have found that research reminds me of writing a term paper- the research and writing are actually quite boring but you just hope for an exciting final result! It has been more and more exciting the longer we do it (and more of a headache!) And I do enjoy my time more when the guys are doing charts with me (they are spending half their time with patients and half doing this research) 

2) I am blown away with the realities of the limited resources hospitals in developing countries face. To begin with, the lack of computerized records. Kalen and I have discussed many times recently that if we won the lotto we would want to buy a computerized records software. There are so many benefits of having computerized records (including the help it would have been for us in this project!). Other limited resources are a lack of individual rooms, blankets, staff, lab results, medical equipment, outdated ultrasound machine, TV's or any sort of entertainment (a patient just stares at the nursing/doctors center desk all day- the ER is just one big open room with gurneys lining the wall and the center desk 2 ft away for doctors to write notes, talk, etc). 

3) For our research, we go through the surgical admissions registry to look for ICD's (intercostal chest drain). Some days, of 30 admissions, 17 of them will be ICD's! It's staggering how many chest tubes (and thus stabbings) they have in this area. Equally, or more, shocking is that by far the number one surgical admission I have seen is for ICA (incomplete abortions). From my development/health graduate courses I have a new understanding and belief about the lack of resources available to women all over the world. 

4) Exciting story- Two nights ago Kalen and I went to sushi for a date night. We were driving down our street to the main road "Beach Rd". I'm driving and turning right onto Beach. To my left I see a man shaking pretty violently laying half in the street and half on the sidewalk. It was dark and I couldn't tell if he had leg braces on or if there was something else by his legs. I am telling Kalen to look, look and we make a u-turn to help him (after I have Kalen give me his wallet and cell phone in case it is an elaborate robbery attempt!) By this point a local jogger and hotel manager have come over to the gentleman on the ground. Kalen jumps out and I stayed in the car. I just see Kalen crouching down talking to this man and the other people. Then Kalen pulls up the genlteman's pants leg and gives him a shot of something from the gentleman's bag. The group continue to help the gentleman for about 10 minutes longer and then help him get up. The hotel manager helps him walk back to the hotel and we see the gentleman has a very bad limp. Kalen gets back and it turns out the man was diabetic and his blood sugar was too high. As he was walking across the street he got dizzy and either passed out or just fell over. He seemed to have some hip problem too which hindered him from getting up. He had been shaking and reaching for his insulin when Kalen came up and Kalen figured out what was happening. But he was also deaf. Before Kalen realized this the gentleman kept signing to Kalen 'thank you' and Kalen was asking "are you hungry?". The gentleman finally pulled out his clip board from his rolling brief case (which I thought were his leg braces when I saw him laying there) and wrote to Kalen that he was deaf. As we were getting ready to drive away the police pulled up behind us (mind you we are on the side street, which is not busy itself) I assume because I had my hazard lights on. We explained why we were pulled over. I assume that our American accents proved to him we weren't up to no good and we weren't lying. I was really impressed that without calling the police, they showed up because of my hazards within about 15 minutes. There may be some very dangerous places in this country but apparently our apartment is not in one of them! I was really impressed with Kalen in this situation. The community's little knight in shining armor.

5) It has been VERY cold this week. We posted pictures from the storm that came through. Buildings have tile floors and no insulation so it's just as cold inside as out, if not colder. The hospital is absolutely freezing. Yesterday I had 4 t-shirts on and a fleece to make me not cold. I feel for the patients who are in hospital gowns with one blanket. 

6) Since the desk we work at is in the middle of the ER, we are in the middle of all the action. Sometimes it is heartbreaking. Yesterday there was an elderly man who was crying for hours. It was difficult to see this man, who I respect for his age, in such a vulnerable position. I felt like his sense of respect was diminished some how by being in the resource limited hospital, with hospital staff that couldn't give him much time because there were so many patients. I wanted to look at him and give him a look of comfort, that I heard him crying and I knew he was in pain- give him even that basic level of understanding from one person to another. But I didn't, because I didn't know what else to do for him. As if looking at him would make him think I was a doctor because I sat at the table. It feels like the wrong decision but I didn't know how else to respond. It's these tiny, little experiences that leave the biggest imprint on my day. 

7) There is MAJOR sports fever here. The Confederations Cup is a world wide soccer tournament that was chosen to play here as a warmup for the 2010 World Cup. (Yeah for US upsetting Spain in soccer!!! We ended their 35 winning streak and Spain is ranked #1 in the world. We will play Brazil on Sunday for the Confederations Cup Championship, Watch it!).  Additionally, South Africa just lost to Brazil in the semifinals and will play Spain for 3rd place.  The ICC Cricket world championships in London was all over the TV here because South Africa made it through to the semifinals!  Lastly, the British and Irish Lions (a selected team of the best rugby players in the UK) came through South Africa and played at venues all over the countryside.  In the end, South Africa's Varsity squad made short work of the Lions (GO SA!).  

8) Along those lines- the marketing budget for 2010 World Cup must be ginormous. They have billboards, bumper stickers, every 3rd TV commercial allocated towards the World Cup. 

9) They also have every 5th commercial and every episode of the local soap operas targeting HIV/AIDS awareness. The commercials are hilarious, I wish I could tape them somehow. And the soap operas are educational (see, they teach you something, they're not all trashy)

10) Leaving the best for last- between the sushi and the wine, I am in heaven.......

Pictures! 1) Megan at Boulder Beach at sunset, hanging with the locals 2) Ostrich at Cape Point 3) Kalen at Cape Point- farthest south point in Africa 4)Storm this week that came through- waves 9 meters high and sea spray as high as the light post!! Pictures from the boardwalk that is one block from our apartment

1) We went to the Two Oceans Aquarium today (Saturday). Kalen took this amazing photo of the clown fish. 2) Another picture from the storm this week. 3) Sunset at our favorite watering hole "La Med"- 4) View from La Med looking up to Lion's Head. This is the bar that after paragliding off Lion's Head you land in the rugby field in the bottom left, unclip and walk up to La Med and order a beer "A man's greatest dream!" 

Picture from Cape Point- looking into the Atlantic Ocean

Kalen and I at Cape Point- False Bay and the Indian Ocean behind us

Kalen's perspective.....

This place is unbelievable. We are 1 block from some of the most beautiful beachfront I have ever seen. Its so amazing. There are literally mansions in my neighborhood. There is a Bently parked across the street from our place and there is also a Lamborghini dealership about 1 mile away.

In contrast, every morning we drive about 40 minutes East, to a city called Manenberg. It is a giant township of 1 million people. Townships are areas of "black" and "colored" people that are basically the poorest people in the entire world. They live in these self-constructed shacks made of metal scraps from the landfills. They are about 10X10 and sleep 5-10 people and are pretty much built on top of one another. There are also government built dorms in the townships and unfortunately the gangs take over the dorms and use them to traffick meth and other drugs. The hospital sits in gang territory and sees some of the most horrific violent crimes. These gangs won't simply rob someone, they will beat you to death for fun, or light you on fire, etc. We are instructed to never leave the hospital after sunset.

The emergency room is  chaos. It's basically this large open pit. Patients admit themselves, most of which are walk-ins, or by ambulance. There are no rooms, the beds are just out in the open and patients just scream or moan all day, you sometimes can't hear yourself think. Literally, everybody has TB and MDR-TB and HIV. I have only seen 1-2 patients who are not infected. Most of what we have seen so far are AIDS complications (that are really horrible), TB complications (i see one person per day whose lung has 100% turned to pus and goo) and violence. Everybody here would be considered homeless by US standards. Some of these poor people haven't showered in weeks, and that is the norm. The ER smells something awful. The doctors here only have the bare necessities. We don't even have gauze pads. There are only 4 mechanical ventilators, so if they are being used and a 5th patient comes in with respiratory compromise, they are simply left to die. Resources are limited and the diseases are ridiculously severe.

It has only been 3 full shifts and my first patient was a guy who walked in with a stab wound in his leg. As I was stitching him, he told me that he likes to smoke heroin and meth simultaneously and then he immediately asked me to hurry because he left his young child at home. Yesterday a 25 year old guy walked in with 3 stab wounds. He made it to the desk and passed out onto the ground bleeding everywhere. I got his IV started and gave him fluids. He finally woke up and Rusty and I stitched his wounds closed. He then told me that he got into a fight with his girlfriend and she stabbed him three times. The last patient I saw yesterday was a 76 year old woman who was left in the care of her son, who neglected her so poorly that 90% of backside was a bedsore/pressure sore that, when I looked closely past the festering wound and the smell of rotten flesh, was bone deep. Only God knows how long she was left lying in that position.

There are officially 20 beds and a holding area with 6 beds and a bench where patient just pile up. Once the beds are filled people just start sitting/laying anywhere and we haven't even worked a busy weekend yet (we are going to work a graveyard this Friday/Sat)!

Then, we leave the hospital, drive home and live in the lap of luxury. It is very very very difficult to wrap my mind around. We have been doing some sight seeing and touristy stuff. I am finally comfortable driving on the left side of the car (shifting with my left hand) and driving on the left side of the road. Even parallel parked last night! We have gone out twice...the nightlife is non-stop. The clubs don't close until sunrise.

Reading reflections

I am reading the book “No Future Without Forgiveness” by Archbishop Desmond Tutu. It reflections on the Truth and Reconciliation Commission of South Africa, which was formed after the abolishment of apartheid. It was a court-body created so any victim of apartheid violence could be heard and perpetrators of violence could give their testimony in return for request for amnesty. It was obviously a very sensitive endeavor. I have been struck with the power of reading it while being here- I can’t begin to understand the true forgiveness and strength encapsulated in this place. Here, in a very moving piece, Desmond Tutu is discussing judging the perpetrators….

“There is a salutary counter to our tendency to push blame onto others in a book by the Harvard theologian, Harvey Cox, with the lovely title, On Not Leaving It to the Snake. This helped me to be a great deal less judgmental and to avoid gloating at the misfortune of others. It was particularly important in the commission’s encounter with the perpetrators of some of the most horrendous atrocities. So frequently we in the commission were quite appalled at the depth of depravity to which human beings could sink and we would, most of us, say that those who committed such dastardly deeds were monsters because the deeds were monstrous. But theology prevents us from doing this. Theology reminded me that, however diabolical the act, it did not turn the perpetrator into a demon. We had to distinguish between the deed and the perpetrator, between the sinner and the sin, to hate and condemn the sin while being filled with compassion for the sinner. The point is this, if perpetrators were to be despaired of as monsters and demons, then we were thereby letting accountability go out the window because we were then declaring that they were not moral agents to be held responsible for the deeds they had committed. Much more importantly, it meant that we abandoned all hope of their being able to change for the better. Theology said they still, despite the awfulness of their deeds, remained children of God with the capacity to repent, to be able to change. Otherwise we should, as a commission, have had to shut up shop, since we were operating on the premise that people could change, could recognize and acknowledge the error of their ways and so experience contrition or, at the very least, remorse and would at some point be constrained to confess their dastardly conduct and ask for forgiveness. If, however, they were dismissed as being monsters they could not by definition engage in a process that so deeply personal as that of forgiveness and reconciliation. …..

None of us could predict that if we had been subjected to the same influences, the same conditioning, we would not have turned out like these perpetrators. This is not to condone or excuse what they did. It is to be filled more and more with the compassion of God, looking on and weeping that one of His beloved had come to such a sad pass. We have to say to ourselves with deep feeling, not a cheap pietism, “There but for the grace of God go I.”

First week done....

We are beginning to feel acclimated with Cape Town- jet lag is over, we’ve mastered left side driving, gotten lost a few times and now know our way around, and visited all the hospitals we will be working at. Cape Town is a stunning place. On our flight on the pilot said, “welcome to Cape Town, the most beautiful city in the world” and it definitely ranks high on the list. It is much more modern than I was expecting. There are very wealthy individuals in parts of the area- it reminds me of Laguna Beach, California to give some perspective. We have seen Bentley cars around.  On the other hand, the townships are very intense. Millions of people crammed into tin shacks. The city, in preparation for the 2010 World Cup, has begun to build government housing in front of the townships to block the view of the townships from the highway leaving the main airport. The government housing is a nice gesture still but none-the-less it will not mitigate the problem and is only to hide the problem.

My first visit to GF Jooste hospital was overwhelming. GF Jooste services a local population of 1.1 million, primarily from townships. As a non-medical student it was a sensory overload, even as a global health student with hospital experience. The smells, the patient load (168% capacity), the patients (TB, HIV, stabbing, an old women was locked (from the outside) inside her township house for days and basically non-responsive still when we saw her)…. It was a lot for a first day. Continuing to visit more hospitals has helped ease the shock of it for me. Today we came back to Jooste and I felt much more ‘present’ and capable of taking in my surroundings.

There have been some delays in getting approval for me to start my research study. I expect to start that by weeks end. I am very much looking forward to starting my work. I am getting jealous of the medical students as they shuffle around Jooste helping the physicians and patients.

For a bit of entertainment, I’ll tell you we have done our fair share of sightseeing in the week we’ve had. We drove down to Cape Point Sunday. Postcard perfect huge crashing waves along the massive, empty shoreline. Something right out of Pirates of the Caribbean or any other ship wreck scene. On our way back we stopped to check out the Penguins at Boulder Beach. I was expecting it to be the ‘off season’ and maybe seen one penguin. Not the case! And they come right up to you as you sit on the bench. There was some wine-tasting another day. I am in heaven here! The beach and world-class wine: tell me what could be better?!

Hope to post pictures later. Until then- wish me luck with continued safe left-side driving!

What we're doing in Cape Town.....

Hello from Cape Town!

Kalen and I are spending the summer in Cape Town (or winter here) along with two other medical students, Rusty and Shannon. I am working on a medical research project evaluating the morbidity associated with the placement of a chest tube in trauma patients. Chest tubes are inserted into the chest and lung to help a person breath and reduce the risk of a collapsed lung, these are almost always inserted into a trauma patient (someone with a stabbing or gun shot wound) as the risk of a lung collapse then is very high. However the lead doctor (Dr Richards from Denver Health at home) hypothesizes that patients with TB and/or HIV are at a greater harm for complications, and possibly death, because of the chest tube. Basically the patients are either so sick that they are at a very high risk for deadly infection or their lungs are so gunked up from the TB that the lung probably wont' collapse and so putting a chest tube in them is harmful. I will be doing a retrospective chart review on chest tube patients and then statistically evaluating the data to test the hypothesis. I will be working out of GF Jooste Hospital. 

Kalen and Rusty will be spending 50% of their time helping me on this chest tube research study and then 50% of their time helping the physicians treat patients in the local hospitals.  They will be working from about 5 local hospitals. 

Shannon will be doing data collection for a hospital capacity study looking at the hospitals capacity rates this summer and comparing them to next summer when the 2010 World Cup is here in South Africa. 

To recap, my trip to Cambodia over spring break was a due-diligence visit on behalf of Deutsche Bank looking into a loan request they received from a local Cambodian micro-finance institution (MFI) called AMK.  In order for AMK to give the small loans  (<$500) to its lenders,  they need capital. The loan request to Deutsche Bank was for this capital. During our week there, we had extensive meetings with every department and the Board at AMK, visited multiple local village offices and experienced a loan payment collection meeting in the villagers home.

The experience was enlightening to understand more about how micro-finance really works. It is such a buzz word in the finance and development world at the moment. I knew it well from books but seeing it first hand gave me a new sense of appreciation for its intricacies.  Everyone is looking for a clear solution to solve poverty around the world and many are quick to diminish micro-finance loans because there are few results that appear sustainable. I realized just how difficult it was to monitor and evaluate the micro-finance industry during our trip. Normal measures of growth (increased annual income, increased literacy rates, improved nutrition, etc.) are extremely difficult to capture from the marginal success of a $100 loan. However, and more importantly, that is not to say growth hasn't occurred. It simply means we as the monitors and evaluators aren't looking at the right indicators. For instance, one family we met with took the profits from their loan and added a wall to their home. Their home now has all four walls. There was a success from that loan, we just need to re-evaluate our own evaluation of it. And secondly, I am even more aware now that the success of micro-finance loans will not come in from this generation. It will be a slow moving fly-wheel that will continue to grow and improve as each generation gets another added benefit- another wall on their house, another year of schooling, another year of life. And one day, a future generation will be able to look back and absolutely be able to see the different the micro-finance loan made years before.

I am pleased to highlight that the University of Denver is the only higher ed. institution in the states that has such a partnership with a leading finance institution working on sustainable development practices, like micro-finance. And my class was the first one offered the opportunity to make the in-country due diligence trip as compared to pure file evaluations from here in the classroom. The trip and evaluations were a large success and we unanimously supported AMK's request to Deutsche Bank.

AMK is doing fantastic work in Cambodia improving the lives of local people. They offer some of the smallest loans in the country thus serving an entire section of the population that most other microfinance insitutions ignore. If you are interested in learning more about them you can check out their website at www.amkcambodia.com . AMK has also partnered with KIVA, an organization connecting individuals to lenders so you can directly provide a small loan to a person in need, as the business prospers your loan gets repaid to you. For more information on this wonderful (and legitimate) connection check out http://www.kiva.org/about/aboutPartner?id=109 .

As a side note, from this very interesting experience I am now evaluating getting certified as a Chartered Financial Analyst (CFA). Who knows what the future has in store!