Cliff Hanger

Holy cow- what a weekend! I am completely exhausted but excited to share my adventures with all of you!

On Friday we headed to Semonkong which is a small town in the mountains. There is a great lodge there that offers a lot of fun activities. One of these activities is abseiling (repelling down a cliff). However, this isn’t just any abseiling- this is abseiling off the highest cliff used for repelling in the world! It lies next to a huge beautiful waterfall and measures 204 meters in height. If you see it from afar it is magnificent! If you see it from the top it is absolutely terrifying.



If you look closely you can see me on this picture of the mountain- just a little speck!!

I was originally very hesitant, but decided that I would probably regret not taking advantage of such a once in a lifetime opportunity! So. . . Saturday morning we were trained on small cliffs near the lodge- piece of cake. We couldn’t do the real thing, however, until Sunday. Therefore we spent the rest of the afternoon on a pony trek through the mountains. Sounds fun right? It probably would have been if my horse wasn’t so sassy. I soon named HIM, Ms. Independent because he had zero intention of actually doing what he was supposed to do. Every once in a while he would decide to gallop, other times he would just stop because he didn’t feel like walking anymore, and sometimes he would just pick his own route straight up the mountain! He ended our ride by taking me through a forest of trees and swiping me with branches in every direction. How I didn’t fall off is beyond me. Luckily the views were beautiful and I was able to get a lot of great pictures. Sadly, Miss Independent and I are no longer friends.

Sunday we woke up nice and early and after grabbing some breakfast, headed to the cliff. There was another group of young travelers from Ireland with us as well, and we had a nice time getting to know them. Once at the top, Alex took the plunge first. After waiting 20 minutes for her to make it to the bottom I was up! I have to say, I don’t know if I was more excited or terrified? Once I made it over the edge I soon found that I would not be able to reach the side of the cliff and would be spinning around in the air for quite a while before getting close enough to the wall. I checked the knots on my ropes quite a bit on the way down. I think I prayed a little more than usual too. Needless to say, I made it safely to the bottom, although completely soaked from the waterfall. . . overall, it was amazing, exhausting, probably the coolest thing I have ever done, and probably something you won’t get me to do again!!

Pictures of me going down, then exhausted afterward!

After the abseiling we soon found that the guides had “failed” to mention how we would get back up the mountain. Say hello to “Melissa the mountain climber”! Unfortunately, the fact that I am not in the best shape along with the altitude basically meant I would be huffing and puffing the whole way up. It wasn’t a climb for beginners either- there were times where I felt like I was rock climbing because it was so steep. So after that experience I have decided not to pick up hiking as a hobby- sorry guys.

I have plenty more to share but will leave it at that for now. I will keep everyone updated with new events on my next blog. For now I am going to call it a day. . . I have a feeling I am not going to be able to move tomorrow!!!!

What's in your backyard?

Some dinner at a local restaurant! Yum!!!!

Wednesday was a very productive day. I spent the morning seeing patients at the clinic. It was nice seeing them on my own and I think I did reasonably well. I didn’t forget to de-worm anyone, that is for sure! The physician that I would check out too was really nice too and she made the work environment very pleasant.

In the afternoon I headed over to Queen Elizabeth II Hospital (Queen II for short). I can’t believe they call that place a hospital. It is one story, full of tiny beds for the kids to sleep in, and there are roaches crawling all over the walls- totally not kidding. Today I just went to meet Alex (she is working on a project to improve child “play” at the hospital). I walked in to see Alex handing out pictures she had taken of the patients. Yesterday, in an attempt to take pictures of the hospital, she was bombarded with patients wanting their pictures taken. Even the moms wanted pictures. She then walked across the street and got some developed so that she could give each patient a picture. It really brightened their day! Many of them have never owned a picture before.

Alex with one of the kiddos (top) & Entrance to the Children's Ward (bottom)


After walking around the “hospital” a little and seeing all the sick kids being “treated”, we headed over to a near by grocery store- Shoprite. While there, I bought a coffee maker. I finally decided that enough is enough- the instant coffee wasn’t cutting it and this cottage needed a coffee maker! I think my future co-workers will thank me!

Thursday I will continue to see patients in the clinic which should be nice and then hopefully I will spend Friday morning in the wards at Queen II. We are headed to Semonkong Lodge Friday afternoon and plan to stay there for the weekend. It is about 4 hours away and is supposed to be just beautiful. You can stay in a dormitory for really cheap so we are going to do that. I should get some great pictures while I am there!

Not much other news right now. I will hopefully have exciting things to update everyone on after the weekend.

The pictures above are views of the backyard at the hospital (top) and the view from my backyard (bottom) . I think my view is better.

A whole new type of medicine

By the end of intern year I think I was finally feeling like a doctor. If you gave me a “bread and butter” case- I could probably tell you how to manage it. or at least knew where to look to find the answer. It felt good to know a thing or two after 8 years of higher education and 1 year of training. . . . unfortunately I think you can throw all of that out the window in Lesotho.

I assumed that I would adjust easily. I know what illnesses to look out for with HIV patients- I mean, I could answer all the questions about it on my board exams. To my surprise it has not been that simple. I can’t think about anything the way I did in the U.S. I have to always remember that these kids are immuno-compromised- which means the door is open to a host of new illnesses. Did you know that Lesotho has the 4^th largest prevalence of tuberculosis (TB) in the world? . . yikes! Most of my patients have HIV and TB. . . which is then a whole lot more disease to consider!

Today I had an HIV positive kid come in with abdominal pain. After questioning mom, doing an exam, and evaluating his growth parameters and vitals, I chalked it up to some constipation. He was growing well, no fevers, looked fine, eating without a problem- at home this would have been a reasonable conclusion. When I discussed the patient with my supervisor she promptly said “Oh, we better de-worm him.” De-worm? I don’t think we even use that lingo in the U.S.. .. can you even imagine having your doctor tell you that!?!? In Lesotho, all the children are routinely de-wormed (we just give them a medicine that flushes the parasites out of their system) every 6 months.

In a lot of ways I just can’t believe how much more disease there is here compared to the U.S. . Props to the states for having such good infection control!!!

Tomorrow I will see patients on my own! =/ Hopefully I won’t have any crazy stories to tell you after that!

I guess that is all for now- I have just been busy working. OH- AND I hand washed my clothes today. . . ugh what a job! We will see how my clothes look when they are dry. . . this could turn out to be an interesting month for wardrobe.

I like kids (but not in a whisper voice kind of way)

Best day so far in Lesotho. We slept in this morning and then headed over to a nearby orphanage for a morning church service. As we got out of the cab I was welcomed by the sound of children singing and clapping. The moment we walked into the worship room we were bombarded by children around our legs yelling “ausi! ausi!” which means girl in Sesotho. I could hardly sit down before I had 3 or 4 of them trying to get in my lap or simply wrapping their arms around my legs. The service required a lot of sitting and then standing with dancing and clapping. I don’t think I clapped once. . . but only because I never was without a little hand in mine. The moment I would sit down I would have at least 2 of them crawl into my lap. It was probably one of the best feelings of my life.

Most amazing was the worship. They had their arms in the air, singing, dancing and praying. I have never felt such sincere prayers. It was so hard to pray for anything but better lives for all of them. They were so grateful to God and yet most of them were wearing smelly old clothing, had their shoes on the wrong feet, tinea capitis (fungus) on their heads, and runny noses to top it off. It really made me realize how much I take for granted.

The day was not without a few bumps. Most of the kids were coughing and sneezing and wiping their noses quite frequently. . . I was glad Alex remembered her hand sanitizer. At one point a little boy that was coughing quite a bit kept raising his arms for me to hold him. I resisted which was probably good because he then threw up all over the place. . . including my shoe. Guess it was better than down my shirt or in my hair!

After getting cleaned up we headed to “Pick and Pay” ,which is the local grocery store, to grab a few things. The grocery store is inside a “mall”. The whole building is about the size of a Wal-mart, but it is very nice. It was only built a few years ago and is probably the nicest place in Lesotho. They have other shops in their as well, including a lunch spot that we have grown to love. It isn’t traditional Lesotho food, but tasty nonetheless. My favorite thing about it though, is the COFFEE!!! I haven’t been able to get a decent cup of coffee here until today. They don’t brew coffee at the clinic and I don’t have a coffee maker at the cottage. I bought some instant coffee which has proven to be very disappointing and often puts me in a highly caffeinated state, and not the good kind.

Looks like we will spend the rest of the evening reading or watching a movie. My skype is acting weird but will hopefully be working again by tomorrow evening. I will let you guys know. Just FYI- prime skype times for me are around 4 or 5 pm my time and 9 and 10 your time!

Oh and one last thing. . . . HAPPY 3^rd BIRTHDAY HAZEL CLAIRE! I hope your birthday party was fun and that you got everything you wanted. I miss you and that awesome family of yours!

"Backsteet's back, alright!"

First Priority for today’s post: Happy Birthday to my amazing husband! I wish I was in the states to celebrate but I know we will have a lot of fun when he comes to join me in 3 weeks! Plus, I know that some awesome people will be celebrating with him!

Today Alex and I went to a near by town, called T.Y., to look at some of the weavings. The woman that ran the place was so incredibly pleasant. She would show us different tapestries and explain the story behind them, or simply what they symbolized. Her words often made the tapestries seem even more beautiful. Additionally she showed us where they make them and walked us through the process. They are all hand made and can take anywhere from 2 weeks to 1 month to make. The picture I have here of the men is one of the most popular tapestry designs- it is called “The circumcision”. Circumcision is an optional cultural ceremony. At one time it was kind of a rite of passage for boys. Usually at age 15 they were sent to live alone in the mountains for 6 months and then would be “honored” with a circumcision. The process remains the same, but it is no longer required. Imagine explaining that tapestry to visitors in your home!!

Alex and I walked around a little bit too and grabbed some lunch at a near by hotel that was known to have good pizza. The weather has been just beautiful during the day so we sat outside where a band was playing. I think we heard some “killing me softly” with a nice Sesotho accent (that is the language spoken in Lesotho). Between songs the singer tended to use a soft sultry voice as though he were in a romantic night club, which was kind of hilarious! Overall it was a nice lunch with a decent glass of wine.

Of note- we had a taxi pick us up to take us to T.Y. in the morning. We got into the car to some regular local music playing, but it was promptly changed to Backstreet Boys by the driver. I wasn’t sure if he thought we would enjoy it, or if he just did. Needless to say, listening to “quit playing games with my heart” as we drove through the Lesotho mountains was quite a memorable experience. =)

We are going to a worship service at a nearby orphanage tomorrow. I am looking forward to seeing all the children- it should be fun!

Missing all of you!

HIV lesson of the day

Today was mostly educational. I went to a lot of lectures that were a review of things I learned in medical school but have never really been able to apply in residency. The lecture I found most interesting covered how the counselors tell the patients about their disease. As a physician, it is so difficult to counsel patients without all the medical lingo. The most impressive part was that the counseling starts at age 5! I was so amazed by this that I thought I would share it with you guys- don't feel obligated to read it- but it is pretty interesting!

So the teaching goes as follows:
Your immune system is like soldier- its job is to protect your body. When your soldiers are present they protect you from the bad guys (illness). Sometimes certain bad guys (HIV) overwelm your soldiers and make you more vulnerable to other bad guys. However, taking your medicine will put the bad guy to sleep. .. so he is still there but can't cause trouble when he is sleeping. If a patient forgets to take their medicine the bad guy wakes up and starts causing all kinds of trouble.

She also made a few other points- like how with education the kids will remind their parents to give them their meds because they don't want to bad guy to wake up. Or how the parents must make sure and put the meds out of reach so the kids don't take a bunch at one time in an attempt to wipe out the bad guy! It was very interesting and I felt very impressed by the counselors ability to relate to the children.

The picture diagrams that the counselor uses while teaching this are at the following website. Just ignore the first few pages with questions and skip to the first picture.
http://bayloraids.org/adherence/files/adherence-supplementary.pdf


On another note. . . .


We had a baby shower today for two of the doctors. They did some singing and a whole lot of laughing! The weather was just perfect too. I hope I take home some of the positively these people exhibit everyday. Oh- and apparently marshmellows are big here. . . they are basically served at every event!

Oh, so this is what jet lag feels like. . . .

So I arrived in Lesotho yesterday around 11 am. The flight from London to Jo-burg (that is what everyone calls Johannesburg here) was horrible. The flight was full and sleeping didn't work so well. The food was not so great either. Luckily my flight from Jo-burg to Maseru was less than an hour and uneventful.

Everyone here is so incredibly nice- I am already in love with the people. I have 3 other girls living with me in the "cottage" right next to the clinic. Two of them are leaving this weekend. The other one is actually my roommate and her name is Alex. Turns out, she is the daughter of my residency director, Dr. Mark Ward. She attends UNC- premed and is going into her junior year. OF the other two girls, one goes to St. Agnes and the other attends Rice. It seems that most people that hear about the clinic are from Houston in some way. Needless to say, I am the old one of the group and am often answering questions about medical school etc. We went out for dinner last night and had a lot of fun. I even peer pressured the girls into splitting a bottle of wine. =) The bread- I think it is called NAN- is incredible. I have a lot to learn about the food and the language and can't wait to explore all of it.

I will have to take pictures but have not yet because I am still in such a fog. I have felt so out of it since I arrived. The bed I am sleeping in is comfortable and plenty warm, but I still had trouble sleeping last night. I am sure in a few days I will be better adjusted.

I shadowed a little in clinic today. . . I have a feeling that learning the HIV management will not be too bad. Everything is very standardized and I have a guide book to refer to. I will probably shadow for a few days and then start seeing patients myself. They have a week of lectures too that should help orient me.

Hopefully I will be able to update everyone a little more tomorrow or tonight. For now I think a nap is in order- I still feel so off!