In Vino Veritas

Saturday (Feb 4)

We woke up and headed to down to the lobby around 8am to meet our guide for the duration of our stay in Cape Town, Angie. Angie was....an interesting guide. My overall impression of her was that she was a nice person but a bad guide -- frazzled, talked too much, did not allow natural discussion or questions, and repeated herself constantly.

Angie arrives around 8:10 and starts talking a mile a minute about our plans for the day -- touring the winelands. She tells us how we'll be heading to Paarl first to visit the Afrikaans Taal Monument since it's a bit too early to start drinking wine. She then asks us which wineries we want to visit for the day and proceeds to schedule those appointments while we are at the Taal Monument (a bit last minute). She also repeated about 5 times how she wants us to visit Fairview Winery first that way we can get some cheese with our wine "to line our stomachs." However, Fairview could not give us an appointment until 11:3o, so we headed to Avondale Winery in Paarl first.

We were given the option to have our tasting outside on the patio overlooking the garden and the wine estate. It was beautiful. We tasted the Armilla (sparkling wine), Anima (chenin blanc), Cyclus (white blend), Camissa (Rose), Samsara (Syrah), La Luna (Cab/Merlot blend). My favorite was La Luna and Dad and Ben really liked the Camissa. The Camissa smelled absolutely wonderful (like a muscado) but the taste was more like a sauvignon blanc.

We then headed over to Fairview Winery in Paarl where they offer cheese pairings with the wine. They also have a goat tower in the front garden and funny shirts displayed in the main area like "Goat do Roam" as a play on "Cotes-du-Rhone" the wine region in France. I really enjoyed the Shiraz wines we tasted here.

After finishing up at Fairview, it was time for lunch, so we headed to Franschhoek to eat at La Petite Ferme. Here we enjoyed some traditional South African food (lamb and boboti), and I also tried to the winery's merlot. The restaurant had a gorgeous view overlooking the vineyards in the valley.

By the time lunch was finished, it was time to head to Stellenbosch to meet Uncle Fanie and Aunt Lisel for tea at Caledon Villa, a house built by my great-great-grandfather and where the current Krige historian, Johan Krige, lives. When I met Johan, it struck me how he resembled my Oupa Marius. I could immediately tell he was a Krige, and I immediately felt at home. Johan gaves us a wonderful tour of the guest house and an informative history of the Krige clan. There are different Krige branches, and I am part of the Caledon Kriges who settled in Stellenbosch. It was so nice to hear about my family history and officially become part of the Krige -Bond.

"Rains Down in Africa" (or at least Jeffreys Bay)

Sorry for the long gap in updates...time and internet became scarce as we continued our vacation.

Last post we left off in Sabi Sabi...

Wednesday (February 1):

We managed to squeeze in a morning safari before flying out of Sabi Sabi. We scoured the grasslands in the northern part of the reserve in hopes of finding my cheetah, but to no avail. We did, however, see a nice male buffalo, a waterbuck, a purple breasted roller, and a male wydah bird trying to impress a female. As we got in the landrover one last time to head to the airstrip, I couldn't help feeling sad. I just never can get enough of Kruger -- it has my heart.

This time we had a slightly larger plane (16 seater vs. 8 seater flying in), and I took a little nap as we flew to Johannesburg. In Johannesburg, we had 3 hours to kill before our connecting flight to Port Elizabeth, so we relaxed in the British Airways lounge where I read and napped some more (I guess those 5:30am wake up calls were getting to me).

We arrived in a rainy and foggy Port Elizabeth greeted by Oupa Pieter. It is always so exciting and wonderful to see the Oupas and Oumas after being gone for a while. That first hug is definitely the best. Oupa drove us through the rain to Jeffreysbay where Ouma Cielie was waiting for us. We had tea, unpacked, and got ready for dinner. Ouma served a delicious beef potjie will all my favorite sides (sweet potato and green beans...yum!). We then brought out our gifts for Ouma and Oupa -- a copy of Rode's Christmas ballet recital and a kindle. Ouma was SO excited about the kindle, and I was glad we were able to get it for her. After visiting over some cappuccinos, we headed off to bed.

Thursday (February 2)

We woke up to more rain and headed off to Le Chameleon for brunch. Le Chameleon is a charming little restaurant and specialty gift shop. The interior is beautifully decorated, the food is delicious, and there are always more than a few unique little items I want to buy for my house. We managed to find a gift for Mamma here as well us some fleur-de-lis salt and pepper shakers for our dining room.

After brunch, we headed back to Ouma and Oupa's house where we showed them our Sabi Sabi pictures and Rode's Christmas recital. They were so impressed with how much Rode has grown up into a young lady and a beautiful ballet dancer. After visiting a bit with Ouma, I did a modified Crossfit workout outside while we had a break from the rain. By the time I finished, it was almost time to head out for dinner, so I took a quick shower before we left for Kitchen Windows. Kitchen Windows is a beachfront restaurant with an incredible view and an extremely hospitable owner, Marius. He came over to welcome us and chatted with us for a while about how we were enjoying our vacation. We all ordered delicious seafood (I got the sole -- soooo good!)

Friday (Feb 3)

The next morning we woke to some more rain, but that didn't stop us from going out to visit the Jeffreys Bay shell museum where they display beautiful shells from all over the world. Afterwards, we went to visit one of Ouma and Oupa's regular coffee spots, the art gallery. This coffeeshop/art gallery has a few tables set up in the back of the gallery, so you can enjoy the artwork while sipping your coffee.

We then returned to home to have a delicious lunch of cottage pie before heading back to Port Elizabeth to catch our flight to Cape Town. Oupa let Ben drive us back to the airport so he could practice a little bit before we rented a car in Ifafi. Once we got to the airport, the lines for check-in seemed unusually long. We managed to check in, get our bags checked, and move through security to the terminal when we hear multiple flights being canceled. Apparently, no flight had landed or taken off yet that day (by this time it was 2:30pm). We nervously sat down at our terminal and hoped that our flight wouldn't be canceled. After about an hour delay, we see a plane land on the runway, and it's ours! We excitedly make our way out of the terminal into the rain to board the plane. Once we are all settled, the flight attendant tells us how the pilot tried to land twice, but had to turn back because the cloud ceiling was too low for a safe landing. On his third try, he had his hand on the throttle ready to pull up when suddenly a break in the clouds appeared and he was able to land. I think we were probably the only flight to make it out of Port Elizabeth that day -- SO lucky.

We arrive in Cape Town to clear skies and sunshine where our driver, William, greeted us. As William drove us to the hotel, he pointed out the major landmarks (district 6, Groote Schuur, Long Street, Strand St, the FIFA stadium, the harbor, and the bridge that goes to nowhere) and gave us some history about Cape Town. He had a friendly smile and an easy laugh, and I enjoyed the brief little tour he gave us.

We get to the Table Bay Hotel where in our rooms we find a bottle of champagne, rose petals on the bed, assorted cakes/treats, and an INCREDIBLE view of Table Mountain to welcome us. WOW. We toasted the champagne to our arrival in Cape Town and then relaxed before dinner in the hotel restaurant, the Atlantic.

"Simba 1, come in"

Blogging from Earth lodge in Sabi Sabi on our last full day here. We have had an incredible time, and this has been a whole new safari experience for me. I'm used to going to Kruger, driving your own car, and hoping luck is on your side to see a cat. Here at Sabi Sabi, A trained guide along with a Shangan tracker drives you around in an open top land rover to find the big 5 and more. Did I mention the guide and tracker will leave the vehicle to track some animals(lion and leopard) on foot to find them, and all land rovers are in walkie-talkie communication? That way if one vehicle spots something, others can find it as well. Oh, and the vehicles go off road to get right next to the animal. Ben and I joked that it felt like Animal Kingdom's safari ride, and we were just waiting for the ranger to come on the radio to say "Simba 1, come in. There a some poachers in the reserve! Head east to help stop them."

Our guide's name is Darred, born and raised in Nelspruit, and is extremely knowledgable and well trained. You can ask him to identify any animal, insect, or plant, and he can not only identify it but tell you everything about it. Our tracker's name is Kenny and he almost got eaten by a lion today when he had to get off the vehicle to hook a chain into the land rover when we got stuck in the mud next to a pride of lions. Did I mention-- open top land rover? Just a little bit scary. Darred says that as long as you stay on the vehicle you are safe because the lion just views it as one big animal- it can't pick out individual humans.

Here is our typical day:

5:30-6am: coffee and tea

6-9am: safari

9am: breakfast

1:30: lunch

4pm: tea time

4:30-7:30: safari

8pm: dinner

Ben and I went in a bush walk after breakfast today with Darred(and his gun). Luckily, we had no dangerous animal encounters on the walk.

A list of the animals we have seen:

The big 5 (lion, leopard, buffalo, rhino, elephant), wild dogs, baboon, bushbuck, duiker, genet, scrub hare, hippo, spotted hyaena, impala, kudu, dwarf mongoose, vervet monkey, squirrel, steenbok, warthog, waterbuck, African tortoise, hinged tortoise, and over 40 species of birds including the giant eagle owl and the spotted eagle owl.

Highlights from each day--

Sunday night:

We set off and soon hear the distress cry of some baboons and a bushbuck. Darred and Kenny head off the vehicle to see what is causing the commotion. They can't find anything but suspect it's a leopard. The ranger comes in on the radio saying they have found fresh "Ingwe" (leopard) tracks-- 2 sets, male and female. We spend most of the night trying to find these leopards, seeing some of the big 5 (elephants and rhinos) along the way. We finally found the leopards at the end of the safari , walking down the road -- a big male in his prime and a younger female. Darred suspects they plan to mate soon. The male marks his territory by spraying urine every few hundred feet, and to quote Darred, "it smells like buttered popcorn" we follow them for a while until they disappear into the grass and we head back to camp. We also saw our first "kill" when the owl we saw was carrying a woodland kingfisher in his claws.

Monday--

We had a nice, relaxing morning safari. We saw a lot of elephants, and we were actually able to get right next to one who was stripping the bark from a tree to eat the nutrient rich layer underneath. It was fascinating to watch. We also saw another group of elephants where the mother bumped the Marulla tree with her head so the fruit would fall down and ripen. Towards the end of our morning safari, we suddenly headed off road to find a young male lion sleeping in the shade. Apparently, his 3 brothers and him were kicked out of the southern pride when two new Kruger males came on the scene. That afternoon, we headed off in the direction of the leopard pair again in hopes to catch them mating. We found them walking down the road when the female started rubbing her tail in front of the male and they started mating. They contain this process every 15 minutes for 2 days. After the mating, they both went to go lay down in the grass. All of a sudden 2 hyaenas appeared. Even though the male leopard was strong enough to scare them away, the female leopard and him ran away to continue mating further down the road. In between the mooning and afternoon safaris we were able to go visit the site of our south African wedding ceremony in Skukuza. The new doctor who lived I that house was kind enough to show us around. It was nice to be back there.

Tuesday--

Our morning was quite eventful. Our first sighting was a group of elephants right by the road enjoying some Marulla fruit on the ground. In the group was a baby elephants, barely a year old, trying to control his little trunk enough to eat Marulla fruit as well. Eventually he gave up and just started suckling on his mom instead. Darred then gets a call of the radio and tells us we a going to drive "a little bit faster" to get to a sighting at the opposite end of the reserve. As we are flying down the dirt road, ben and I are bouncing out of our seats, and I'm hoping we are heading to see a cheetah. As we get closer, Darred tells us that it's a pack of wild dogs who just got chased off by the pride of lions. As we get closer, we see pride laying in the road. Darred goes off road to get around them to go find the wild dogs, and this is where we get stuck in the mud and kenny has to get off to attach the chain to the car. We got pulled out of the mud by another land rover and headed in the direction of the wild dogs. We found the pack of 8 trotting down the road. We were able to follow them for a while before heading back to the lodge. The lions in the meantime had chased a buffalo into the neighboring reserve, so that was the last we saw of them. Tuesday afternoon we headed down to the southern section of the reserve near the Sabi river where we saw two rhinos and were able to get some beautiful pictures. We also stopped to have sundowner drinks at a spot overlooking the Sabi river. It was breathtakingly beautiful. You really can never get enough of the African bush.

HAITI: Day 7 -- PIH and some R&R

06-25-11

We packed up said goodbye to our modest little home of the last week and headed back to Port au Prince for a day of rest and relaxation with a stop at Partners in Health (PIH) along the way. When you enter the gates of PIH, you feel as if you’re entering a major compound. The driveway winds up to rows of concrete buildings. Some of the buildings serving as the hospital, others as homes for the patients, and other as community centers where women are taught skills to start local businesses. One of the community healthcare workers started us off on a walking tour of the outside of the compound.

At one point, we ran into a little boy who called himself Anyo. As he saw me, he asked me “Kreole? English?,” and I tried to explain to him that I only spoke a little Kreole…could he speak English? He told me yes and then proceeded to tell me “My name is Anyo” in perfect English. He was so friendly and outgoing, and the first child I met that could speak any English.

As we continued the tour of the compound, spiraling higher and higher (the compound is built on a mountain/hill), the views kept getting more and more beautiful. We finally reached the peak where you could see “mountains beyond mountains” (the appropriate name of the book about Paul Farmer and PIH in Haiti). After enjoying the view, we headed back down to tour parts of the hospital. We toured the internal medicine ward, the surgery ward, the maternity ward, and the TB ward. By “toured” I mean we would go to the entrance of the ward and a hospital worker would tell us some facts about the logistics of that specific ward. It was interesting to see in the maternity ward, posters of the treatment protocol for raped women as well as promotional material for the contraceptive injection. The hospital is the best medical facility I have seen in Haiti, and overall, PIH impressed me.

After a very bumpy (think huge potholes and crazy,/no rules, traffic), we arrived to our hotel in Port au Prince—Karibe. It was such a strange feeling going from working in makeshift clinics in the dirt where finding clean water was a huge problem to a five star hotel with a massive pool containing a built in bar. It very much typified the contrasts of Haiti—the huge disparity between the wealthy and the poor, the beautiful scenery dotted with makeshift shacks for housing, the smiling baby covered with a festering skin infection.

We enjoyed our time at the hotel, taking advantage of the pool and everything else the hotel had to offer—a celebratory ending of our trip to Haiti.

Overall, I enjoyed my trip to Haiti. It was fulfilling, frustrating, heart breaking, heartwarming, educational, and incredibly fun. The country has countless problems, but the people are resilient, and that gives me hope.

HAITI: Day 5 & 6 --working in clinics

06-23-11 -- Clinic in La Hoyt

Today was market day in Thomonde. The local women had put out all of their homemade goods to sell -- beautiful embroidered tablecloths and colorfully embroidered scrub tops and dish towels. They also had all kinds of carved wooden bowls and other decorative items. I ended up getting a great tablecloth with "Haiti" embroidered in the center.

After the market, we again made good use of our rented landrovers as we crossed rough terrain to reach a rural clinic. At one point, the drivers even stopped to evaluate if they could even travel further on the "road." When we arrived at the clinic site, we saw it was a local's house. They gave us use of their kitchen for our pharmacy and 2 other bedrooms for our other clinic rooms. One of the local doctors from the nearby town, Casse, joined us -- Dr. Jean Baptiste. At times there was some tension working with him, but having him there helped us see a lot more patients.

I was assigned to the adult clinic in the morning and the pediatrics clinic in the afternoon. My first patient was the sweetest 80 year old lady who was complaining of generalized pain (abdominal, knees, hips). We ended up giving her some pain medication and antacids. Another one of my patients was a 40 year old man who had his 10 year old son with him. As we were talking, he kept coughing, and when I listened to his lungs you could hear crackles/wheezes in all of his lung fields. As we continued talking, he admitted to smoking cigars everyday for as long as he could remember. I suspected he had COPD complicated with an infection and Dr. M agreed, so we gave him an antibiotic and an inhaler.

In the afternoon, I saw the healthiest/happiest baby I've seen in all the clinics. She giggled as pulled my stethoscope out to listen to her heart. She turned out to be perfectly healthy, but as we were wrapping things up, Lenny, the translator, suggested that I have a sexual history discussion with the mom since she looked VERY young. I agreed, and although she seemed a bit embarrassed, she ended up deciding to get an HIV test at the clinic.

I ended clinic feeling hot, tired, but happy about the patients I got to see that day.

06-24-11

Our last day in clinic...it came so fast.

The night before, as Sameer was confirming our clinic day with TonTon (another medishare liaison), we discovered there had been some kind of miscommunication and there was no clinic scheduled for our last day. After Sameer talked to TonTon to see if there was any way we could still do clinic, Tonton agreed to see what he could set up for us.

Thus, our hopes weren't very high as set out for our last clinic day thinking we were just going to be helping out Dr. Jean Baptiste (the Haitian doctor from the day before) in his clinic. As seems to be the case in Haiti though, you never get what you expect. We were pleasantly surprised as our drivers dropped us off at a school building with about 50 moms with babies waiting for us, so we could set up clinic as we had the days before.

Wet set up clinic in the concrete school classrooms with windows cut out from the wall that the local children peered through all morning and afternoon.

I started off the morning in the peds clinic working with Allison (one of the peds docs). I saw a lot of healthy, happy babies, which was fun and uplifting. There was one 4 month old in particular that just kept smiling at me in the most adorable way. The rest of the kids mostly had minor illnesses -- sinusitis, URIs, and abdominal pain.

I spent my afternoon in the adult clinic with David (our internal medicine doc). There were a few patients that had the same complaints we had been hearing all week -- URI, headache, generalized pain, but I also had some other, more unusual, patients. The patient that touched me the most was an elderly man who presented with generalized pain, but Youseff (who was triaging patients that afternoon) said that something seemed off about him, and when I started asking him questions, he was barely able to respond. His wife then described how he had been acting bizarrely for the last week or so...almost going into hysterics at times. When we asked if anything in his life had changed recently, his wife revealed that their son had been in horrible traffic accident, and that's when the husband's bizarre behavior had started. David thought he might have the beginning stages of dementia and referred him to the nearest hospital for evaluation. Afterwards, Youseff was telling me how often times, elderly patients can get something called post traumatic dementia after a particularly distressing experience. I can't even imagine what that poor man must have been going through, and there was nothing we could really do to help him except refer him to a hospital for more testing.

HAITI: Day 4 -- Clinic near Marmot

As we set out for our second day of clinic, we stopped by the newly finished Marmot Maternity Center. Staff includes 3 ambulatory nurses and support staff. They are still looking for a doctor and a midwife, but Marie said they were currently talking to a midwife who would most likely fill the position. The clinic had 2 NICU beds, and observation room, and a maternity ward. It's definitely progress and will fill a huge need in the community.

We then continued on to our clinic site. Rough roads again, but not quite as bad as the previous day. Looking out my window and seeing all the little kids -- on horses, carrying water, waving at the passing car-- I felt hopeless. Haiti/Medishare is making progress -- the maternity clinic and the nutrition factory, but the way these happy, outgoing kids were living just made my heart ache.

I spent the morning in the pediatrics clinic with Susan. It was so hot (no air flow) that I was trying my best just to not sweat on our patients. We even had a few students who were sweating so much that they soaked through their scrubs. Our patients had a lot of non specific abdominal pain (most likely due to worms) and some upper respiratory infections. We also had a girl with rectal prolapse. Apparently she had an operation for it a few months ago, but it had reoccurred. The mom was very worried about it, and said every time it happened, she had to push it back in. There was very little we could do for her, so we just suggested she returns to the surgeons who did the operation.

In the afternoon, I worked on pediatric triage with a local nurse. This included height and weight measurements, temperature, and arm circumference. The local nurse was invaluable -- she could communicate with the mothers and children to get the most accurate weight and height measurements. Triage also provided some down time to just play with the adorable little kids. There was one 3 year old wearing her mom's wide brimmed hat who came over and decided to play peek-a-boo with me --so adorable :)

It turns out we got done with the pediatric patients before the adults, so I moved outside to try and triage the adults since we probably wouldn't have time to see them all. I started off taking vital signs and sent in patients with extremely high blood pressures. We then realized we had time to see even fewer patients than we though, so I started going around with a translator to get the patient's chief complaint. While we were walking around, Woon Cho came out and spotted a sickly looking man and looked at his health record where it stated he might have HIV. Woon Cho immediately took him inside. One of our doctors, David, works at the AIDS clinic in Atlanta, so we took the patient to see him. Since we have no HIV medication, David wanted our patient to go to the nearest hospital to receive treatment. After finding out the man could not afford transportation to the nearest hospital, David collected money and gave it to the man.

While I was triaging, there was another woman complaining of an eye problem. I unfortunately had to tell her that we had no eye medication we could give her. On the ride home, we discussed how it would be really helpful to bring an opthalmologist on the next trip since so many of our patients had eye complaints related to working out in the bright sun without any eye protection.

On the second day of clinic there were quite a few interesting cases in the adult clinic where we could either provide treatment or refer the patients to a center where they could receive care. Overall, it was starting to feel like were having some kind of impact.

HAITI: Day 3-- Clinic in the Mountains

06-21-11

Before heading out for our first day of clinic, Marie offered to give us a tour of the Akamil nutrition factory and the new Medishare compound.

Akamil is a legume and micronutrient enriched millet. The main goal of the Akamil plant is to improve malnutrition in the area. The plant also aims to provide microbusiness to the community through women precooking the millet before selling it as well as providing jobs as factory workers for local community members. Right now, the plant is funded through outside grants, but the goal is for it to be self-sustainable. One of the ways they hope to accomplish this is through mass production and sale in larger grocery stores in Port Au Prince. Other parts of the plant are used for chlorine packet production (for treatment of water) and water container buckets. These buckets have a spicket and no handle, so they can only be used as the family’s water container.

The new medishare compound is very impressive and should be completed with in the next year. Not only will it include updated living facilities, it will also include a conference area where Medishare can host potential donors and collaborators.

We then headed out to clinic in an extremely remote part of Haiti. We had rented 4WD vehicles for our trip, and the journey to the clinic site made me see why – we traveled through rivers, across rocks, through mud, and up mountains. A little nerve racking, but our drivers were very skilled.

When we finally reached our clinic site, we found ourselves in a local church that was home to quite a few tarantulas. The presence of people scared them away soon enough and we started setting up our supplies. I spent the day in the pediatric clinic with Allison (the other pediatrician on our trip). Our first patient was a little girl with a severely burned arm. We debrided the wound and gave her mother some ointment and additional dressing to keep taking care of it. We also gave her some antibiotics to keep any skin infection away. The rest of the cases mostly consisted of stomachaches, diarrhea, and upper respiratory infections. We had to leave a bit earlier than expected due to rain (and the extreme roads that would become worse in this weather).

I left clinic feeling sad for these people in these destitute conditions and thinking, “Are we really making a difference?” Sure, we treated 1 acute case – the girl with the burns, but the other problems are just symptoms of larger societal problems – access to healthcare, access to clean water, access to education, access to foods with proper nutrition, and access to proper housing.