Cape Town and Home

We arrived in Cape Town on Friday night. It was a pleasant trip but frankly I think we were both ready to head home. Our first introduction to Cape Town was the massive "township" around the airport. South Africa is famous for these townships but we really didn't see them on our trips to Johannesburg. Townships consist of shanties that are placed on unoccupied land. The are of course very small and they're right on top of each other. The townships are huge and go for as far as you can see in some places. This is urban poverty as opposed to the rural poverty we saw in Malawi. The South African goverment is doing a lot to try to replace these townships with sturdier housing. Also most of the homes in the towns were electrified and clearly had television.

We arrived at our small hotel near the center of the city. Behind the locked gate, it was quaint and modern at the same time. The white walled common rooms had simple colorful watercolor prints signed by "NMandela". Two dens, dining room, kitchen and serving areas were small, inviting and spotlessly clean. The owner, a former nurse from the UK who had worked in South Arica with Physicians without Borders, was gracious and tremendously knowledgable about Cape Town and S. African life and recent history.

The next morning we got up early and purchased a ticket on the On0ff Tourist Bus and toured through much of Cape Town. It is an astoundingly beautiful city nestled between Table Top Mountain and the Atlantic. The Table Top Mountain is accessed by a cable car and the views from the top of the Mountain are spectacular. The coast is also very beautiful with nice beaches, lots of rocks and huge waves.

We stopped for lunch at a very nice Indian restaurant along the beach and had delicious Indian food (one of our favorites and we hadn't had any real Indian food the whole time we were in Africa) and watched the surf - it doesn't get much better than that. That evening we had dinner at a small family owned restaurant a few blocks from our hotel. Their specialty was fish (another favorite we hadn't had in a long time) and it was a very pleasant meal.

On Sunday, we hired a tour guide and took a trip through the more rural parts around Cape Town. This included a trip to Stellenbosch which is in the heart of the S. African wine growing region. We had to stop to sample some of the local product to see how it compared to our own upstate New York wines. The S. African wines are quite good and (at least in Africa) very cheap.

From Stellenbosch we proceeded to the coast which is really beautiful. The mountains come right down to a rocky seacoast. It's quite odd to look out over the ocean and realize the next land is Antarctica. One curiosity of this region is that they have penguins! They're quite small and not like the ones you see in Antartica on TV but as you can see from the photo they're clearly penguins. Most of them are on a few beaches that have been set aside as national parks.

As you can see from the picture of Carolyn it was quite cool in Cape Town. It is after all late fall and at this point in our trip we are about as south as you can go in Africa. Cape Town does have a winter with occasional temperatures below freezing and snow in the mountains.

That afternoon we proceeded to the Cape of Good Hope itself which is a national park as well. In addition to the mountains and seacoast they also have a large number of animals in the park including antelope, baboons, monkeys and also apparently some lions. We then returned to our hotel in Cape Town for dinner and to get ready for the flight home.

On Monday we got up for a leasurely breakfast, final packing and headed to the airport. Our trip home took us back to Johannesburg for about a 5 hour layover and then we boarded for the 17 hour flight to Atlanta and from Atlanta to Syracuse. Amazingly in our entire trip we didn't have a single delayed flight or a lost bag!

As we arrived back in Syracuse I was struck by the verdent green of our spring countryside and the amazing affluence of America. We are certainly blessed to live in this part of the world.

Our trip to Africa was really quite an experience and we already miss the many wonderful people we met there. But as usual with traveling, returning home is one of the nicest parts of the trip.

On Safari

On Thurs April 29, we drove with Darlene and Paul from Mzuzu to Lilongwe. The ride through the highlands of Malawi was beautiful and it was surprising how undeveloped that section of Malawi is. It is largely a forest and wood production is the major industry. In Lilongwe, we enjoyed a pleasant dinner at a nice Italian restaurant.


On Friday, Darlene and Paul took us to the airport. Sadly, our stay in Malawi came to an end as we boarded a plane back to Johannesburg. We loved our time and experiences in Malawi and will miss the many new friends we made there.

In Jo-burg we went to the Apartheid Museum which is very well done and quite moving. It was interesting how little of that history we knew despite the fact that it all occurred during our lifetimes. I think we Americans were preoccupied with our own history at that time.

On Sunday we caught a flight to Maun, Botswana where our safari began at a lovely lodge called Motsentsela Tree Lodge. The lodge was very nice and located in a game reserve. The room was luxurious although it was a tent! It had a shiny polished wood floor, modern double sink, footed bath tub and an outdoor shower: the nicest tent we've ever stayed in!

The safari began in earnest the next day when we traveled by land rover to Moremi National Game Reserve on the Okavango Delta. The Okavango is a river that begins in Angola and flows 800 miles to Botswana where it empties into the desert and evaporates without ever going to the sea! This area is a natural bonanza for wildlife and the waterways and swamps have kept the area virtually undeveloped except for occasional Bushmen settlements. I have included only a small sample of the animals we took pictures of. We saw many elephants and various types of antelopes as well as lions, leopards, worthogs, and giraffes. The bird life is phenomenal.







We also saw hippopotomus, monkeys and baboons. These were not occasional sightings, many times we saw 4 or 5 different types of animals at once!

































In all we saw 32 different mammals! Travel is extremely primative and mostly over very rough dirt roads. On one occasion our land rover got caught in an elephant hole! But as they say in Botswanna - "Not to worry". It turns out that this is a very routine problem and our land rover was equiped with a "tall" jack that simply lifted it out of the hole. We put rocks under the wheels and after a few moments (and of course a cup of tea!) we were on our way.



Then we took a long ride to Chobe National Park. Chobe is a beautiful park along the Chobe river in Botswana. The animal life here was even more striking than Moremi - if that's possible.



During all of our trip we were accompanied by 3 other travellers and our stellar guide Stanley Dube. Stanley is a Zimbabwian with phenomenal knowledge of the animals of southern Africa and is a remarkable person. He tracked lions, leopards and various antelope all over the parks until we found the animals. During most of the safari we stayed in mobile tent camps. The staff of the safari set up and broke camp while we were on our game drives, laundered clothes, and cooked meals over an open fire! Every night after a long day of chasing animals we came home to warm showeres and wonderful meals with our choice of wine - tough duty and quite a change after Malawi!

Our only dissapointment was that we couldn't do much hiking. It's illegal in the parks of Botswana because of the presence of large predators i.e. lions and leopards that could threaten humans. Even the elephants, zebras and buffalo can be dangerous. Before we would get out of the land rover, Stanley would always check the bush for predators.



The last part of our safari was a trip to Livingston, Zambia to see Victoria Falls. We stayed at the Royal Livingstone Hotel, rated one of the "10 best hotels in Africa." It has maintained the style of colonial Africa. The property was on the shore of the Zambezi River at the head of the falls. We took a walk along the rim and were promptly soaked to the skin by the mist, even with raincoats. Our "butler" was a miracle working in drying out shoes! The other unique employee at the hotel was the monkey chaser. The monkeys were so bold that they would steal food right off the tables. The chaser had a slingshot which he never used, because the monkeys just had to see him and they gave up.

We left Livingstone on Friday the 14th for the last stop of our trip, Cape Town.

Mzuzu

We've been having a great time with our friends Darlene and Paul Heller who run a crisis nursery in Mzuzu. They've needed a break and so they took some time off. We've traveled around Mzuzu, spent a lot of time in the market, visited Mzuzu University's school of nursing and other health care facilities in the area.

Recently there was some great excitement in Mzuzu. An elephant got into some of the villages around Mzuzu (within a few kilometers) and killed two villagers. Unfortunately, the game wardens had to put it down - it was apparently a big bull. We got to see the elephant, with many Malawians, at the local nature preserve. It was sad they had to put it down - what an amazing animal. It weighed 5000 kg. Interestingly, for many Malawians this was the first time they saw an elephant so it created quite a sensation.

We spent Sun to Tues at a lodge on Lake Malawi where we swam, relaxed, went to market in Nkhata Bay, and played cards. Most importantly, we shared many laughs which is so therapeutic . All in all a very relaxing time. We're now back in Mzuzu and preparing to return to Lilongwe and catch our flight back to Jo-Burg, S. Africa.

Leaving Lilongwe

On Saturday, April 17th we left Lilongwe for a quiet day on Lake Malawi. We headed east to the Rift Valley which is a gigantic fault that runs the length of most of Africa and forms the valley in which most of the anthropologic data on the origins of man has been developed. The living conditions remain basic with wood providing fuel, water sources are tennuous and food is extremely insecure. The amazing thing is how well people do with so little. Currently there seems to be adequate food but there is great concern that the harvest was poor and there won't be sufficient food to get through the dry season.

The lake is spectacular. It is about 50 miles wide and the mountains of Mozambique can be seen across the lake. The lake is very rich with fish and the fisherman fish from dugout canoes in the middle of the night but pull in large amounts of fish - an extraordinary source of protein in a nation very short on protein sources. We spent a delightful day on the lake and then left for Mzuzu where we are staying with our good friends the Heller's who have been working in Mzuzu running a crisis nursery for 2 years for orphans. We did a mobil clinic in a small town about 50 km away. I think the people were the sickest I've seen. There was a huge amount of malaria particularly in the children. Also HIV, schistosomiasis, intestinal helminths, elephantiasis etc.

On Tuesday, we went to Vwasa National Park where we saw a lot of elephants, hippopotomus, baboons, and birds. On Wednesday, the group we've been working with headed back to Lilongwe to prepare for their flights home. We've stayed with the Heller's and did medical exams on the babies in the nursery and all the staff.

On Friday and Saturday we relaxed and celibrated Carolyn's birthday. The internet remains intermittent but we'll try to keep in touch as we go forward.

Chichewe (I apologize in advance for any spelling errors)

English is the official language and is widely spoken in Lilongwe, but not far out of town you need to be able to get by in some of the other languages of the Malawian people. Chichewe is one of the languages of Malawi, and is spoken in the region around Lilongwe and some of Zambia. It is an ancient but interesting language with lots of humorous twists. The words for tea - chombe (more specifically a particular kind of tea grown in Malawi), fish – chambo (more specifically a fish found in Lake Malawi) and marijuana – chamba are beautiful examples. Imagine the surprise on your waiter’s face when you think you are ordering fish or tea but in reality are ordering marijuana!!

A similarly humorous event occurred yesterday in one of the villages where we were seeing patients. I still haven’t figured out all of the linguistic particulars but I was in my “office” (which was really a classroom for the local school) seeing patients when I needed to take break to go to the men’s room. I asked my interpreter where the chibuzi (outhouse) was but apparently mutilated the pronunciation and asked him for the chibanzi (the name of the village) instead. Imagine my confusion when he told me I was already standing in it!

Finally, in Malawi when one is riding in a lorry with 25 other people to go to a clinic in a small village and you need to go to the bathroom, the proper way to make your needs known is to say (in English or Chichewe) “I need to wash my feet”. I leave it to your imagination to figure out where this phrase came from!

We continue to enjoy our trip to Malawi and the people are truly wonderful and extraordinarily grateful to have us here to help. Carolyn and I are both enjoying practicing medicine again and are grateful to the Malawian people for reminding us what a great privilege it is to be a physician. To work in Malawi we had to get a license which cost $250 each – a price arrived at after a few days of negotiations! We are now free to practice throughout Malawi. We continue to see extremely interesting patients. We are seeing a lot of malaria (including a case of cerebral malaria that needed to be rushed to hospital – on the back of a motor bike), tuberculosis, starvation in all its horrible but varied presentations and of course all of the various parasites. We also see diabetes, heart disease and hypertension although in much lower frequency than in the US.
We hope all is well with you and we think of all of you frequently.

Getting Down to Work

Muli bwangi (how are you in Chechewa) to family and friends,


I apologize for not writing sooner, but we have been incredibly busy. In the last week we have seen things that I must say I never knew existed.


We have visited two clinics in the bush - Khwamba and Salengo. We get up at day-break and ride many kilometers over very dusty, deeply-rutted and pot-holed dirt roads. As you might imagine the trips are interrupted by the occasional flat tire! Literally hundreds of people walk many kilometers to see us. Usually we are greeted by mobs of children and when we get to the villages the populace sings as we set up. The Malawians love to sing and dance and they are quite good at it. They sing songs with multiple harmonies and of course it’s all a capella. The villages are very poor - no phones, power, running water or toilets but the kids are quite resourceful (see the picture of the kids with their "soccer ball").


We have seen a lot of malaria and parasitic infections. April is the end of the rainy season so malaria is rampant and the people have not seen a doctor in months because the villages are inaccessible in the rainy season. We’ve also seen a lot of diarrhea and the usual pneumonias, hypertension and “I hurt all over”! Fortunately, we have an outstanding lab technician (Stanley) who is very good – particularly in malaria and parasites. We are of course at risk for malaria as well but are on prophylactic medications and sleep under a mosquito net (see picture).


We visited three hospitals in Lilongwe. One was a government hospital for obstetrics. They do about 1100 deliveries a month (as a point of reference, Crouse Hospital does about 200). The amazing thing is that they do this including C-sections without a doctor! The care givers are all clinical officers – high school graduates with only three years of education. The hospital is spartan by American standards but clean and neat.


We also visited an AIDS hospital run by the Partners in Hope. It also was quite basic but does an excellent job of taking care of AIDS/HIV. The anti-AIDS medicines seem widely available in Malawi. Amazingly, they can do much of the most sophisticated AIDS testing involving complicated equipment but can’t do something as simple as creatinine to measure renal function. Clearly there are very different priorities in Africa.


We also spent time at Daeyang Luke Hospital. This was a gorgeous hospital built by a Korean shipping magnate. I gave a lecture there on AIDS nephropathy that was well received. The hospital has a very open layout with many breeze ways and a gorgeous view of the valley and distant mountains. All of the hospitals require the family to provide a guardian to accompany the patient in the hospital to help provide care. If you can’t provide a guardian, they won’t accept you as a patient – an interesting concept that deserves some consideration in the US.

Chickens are every where in Malawi but as you can see from the picture to the left they are not permitted in my exam room!

Yesterday, we spent at the Crisis Nursery in Lilongwe examining staff and people in the neighborhood. So many patients came that we had to send them away – our staff tried to screen them so that the sickest were seen first.


Today is Sunday and in Malawi it is a quiet day. We went to church and were the honored guests. Again the singing was beautiful. On our way to church we went through an extremely poor urban neighborhood where the children were picking through large rubbish piles looking for anything useful. There are many sad things to see here.


This afternoon and evening we’re planning to just relax and spend time with our new acquaintances. I suspect next week will be extraordinarily busy as well.

We miss you all.

We are getting into a routine here in Lilongwe.
We are staying with most of our group at Nelly's Guest House. It is a small place on a side street in a nice neighborhood. As with all of the homes in Lilongwe, the compound is enclosed by a tall brick wall with a gate and a 24 hour guard. We're not sure if this is for security or is a status symbol! Inside the wall is a pleasant garden, the main house, and a row of other rooms.
After breakfast (which most mornings has been cooked on a charcoal grill since the electricity is very unreliable), we are met by the van from Ministry of Hope which takes us to the Crisis Nursery.
The drive is fascinating: only the main roads are paved; the rest of the roads are rutted red clay. In many places the driver has to creep along to avoid the deep pot holes. Along every road people are walking: men, women carrying bundles on their heads, children. There is little public transportation and most people walk to work or to distant bus stops. Crops are planted right up to the side of the road, mostly corn but tobacco is a big crop for export, too. Right now everything looks very lush at the end of the rainy season, but we are told that in October all of the vegetation is brown.
At the nursery, we have been busy sorting medications which we will take to the clinics next week. We are getting to know the others in our group: Ken Root (a neurologist who is the organizer of the group), Jim Schumaker (a family physician from northern Wisconsin who is making his second trip to Malawi), Caryn (a fourth year medical student who is going into pediatrics), Donna (a fourth year medical student who is going into Internal Medicine), Mary Jo and Pete (members of a church from Hilton Head that supports MOH), and Fran (a nurse from Phoenix who has been involved with MOH in the past.) Every now and then we take a break to play with the babies.
Back at the Guest House in the late afternoon, Paul and Jim have started a tradition: they have one Kuche-Kuche, an almost non-alcoholic beer, before dinner. This is a good time for more good conversation, frequently to candle light because the power has been lost. The generator eventually comes on, but only powers the lights and not the air conditioning, refrigerators, wireless router, etc. This makes for early bedtimes.
Tomorrow we will go to a Malawean church for Easter Sunday. Everyone tells us it will be a remarkable experience. We are looking forward to it.

On to Lilongwe

Today after a 5:15 am start we headed back (with all our luggage!!!) to the airport in Johannesburg. Despite getting there over 3 hours ahead of time we didn't get to the gate too early. We also had to pay a substantial bill to get all our supplies to Malawi. It's a bit frustrating when you realize that all of the supplies were donated from Americans, you would think South African Airlines could cut us some slack.

Anyway, be that as it may, the flight to Lilongwe was smooth and almost on time. The Lilongwe airport is a sight to behold. At least 2 flights came in at once and there is only one luggage carousel. The crowd must have been 5 people deep. Eventually, we got all the supplies and met the people from the Ministry of Hope who will be guiding us around for the next few weeks.

Our first stop was the Crisis Nursery in Lilongwe. They have about 22 orphans under the age of two there. The staff is phenomenal. These kids look amazingly good, particularly when you realize how sick they were when the came to the nursery. The staff is technically good with limited resources and they have a huge amount of love for the kids. Not being able to resist, we got involved right away (see the picture if I can get it to upload). Some of them are HIV positive and the one on the left was thought to have malaria but the blood test is still pending. Note how much thiner and floppier he appears. My years of doing pediatric nephrology are already starting to pay off in Africa.

Tomorrow we will start to get all the supplies organized and ready for our trips to the villages. The people of Lilongwe look well and properly nourished but we're told that in the villages it's quite a different story. The landscape is verdantly green at the end of the rainy season and there are crops everywhere, even in the city. At this point it is hard to know why there is so much starvation although I'm sure we will be learning much more. Sometimes the up-coming dry season is called the "season of starvation".

First Day in Africa

We had a quiet day. We spent most of it relaxing and getting used to the new timezones. After a late breakfast we went to the mall in Johannesburg to pick up some last minute items. The mall was neat, clean and modern but smaller than Towne Center in Fayetteville and it is rumored to be the nicest mall in Johannesburg. I'm hoping this got the shopping out of Carolyn's system for a while.

Our hotel was on the outskirts of Jo-burg in a relatively rural setting. Check out the accompanying photo. The homes are remarkable for their diversity - from very small, downtrodden places to very nice homes.

All of the people we've been involved with are delightful. The hotel personel met us at the airport and helped move all of our luggage. Most of the people we've met at the hotel are expatriates from Zimbabwe, where the president is Robert Mugave. He is causing issues for many folks in that country. Most of the Zimbabwean expatriates work here for 11 months and go home for 1. They usually leave their children with relatives in Zimbabwe and send money home. It's hard for us to imagine but they seem happy.

It's also quite interesting to be in a country where you are an obvious minority. We feel quite safe and comfortable but do we stand out!

Arrived on schedule after a delightful but long flight. We both got a good 7 hrs of sleep and I got a lecture written!! Nothing like being locked up in a tin can to focus your attention.

The guest house we are at, Africa Sky, is delightful with great food and wonderful staff. We’ll probably crash tomorrow and do a little site seeing in Johannesburg. Then on Thursday it’s on to Malawi. Ken, all supplies arrived intact without a scratch on them!

We Like to Travel Light!

Do you think the plan will get off the ground!

One more item on the "to do" list for our trip is completed: setting up a blog. We look forward to sharing our trip with our family and friends.