Up Close and Personal

For our second weekend in South Africa, we took a three-hour drive north to Hlue Hlue Game reserve to see some local wildlife. We weren't sure what to expect but on a brief drive from the park entrance to Hilltop Camp (accomodations within the park), we had already walked within 20 feet of a grazing rhino, spotted zebras and scared off a small antelope.


The next morning we were up before dawn for a walking tour. We picked up our guide and his large rifle (yes, he'd had to use it before) at around six and drove toward the trailhead. As we came around a bend in the road, we startled a lioness with three cubs (less than 2 weeks old according to the guide) from their resting spot on the pavement. I stopped the car, cut the engine and, amazingly, she sat back down in the road and the cubs went about playing with each other, around 100 feet from the car. After a few minutes, one curious and brave cub began to walk in our direction, prompting the mother to also walk in our direction, in turn prompting the guide to politeley request that I roll up the windows. It turns out it was good advice- she continued past the car, around 2 feet from my driver-side window, which gave us an appreciation for the cat's size (her head would probably have come up to my mid chest if I were standing) and a little adrenaline surge despite the closed windows. The cubs came next, but were not bold enough to walk directly past the car, instead taking a little arc in the grass and stopping every few feet to check us out. The walking tour was less eventful than the drive, but worthwhile.


A few hours into our afternoon drive, we rounded a curve on a dirt road to see two parked cars, and around 50 feet beyond that a large number of elephants crossing to get to a river. We eventually got the impression that the herd had passed and we were impatient with a carload of loud teenagers so we pulled forward, ahead of both of the other cars. When I looked up, I saw that we had managed to park around 20 feet from the back end of a massive female elephant- a little too close. She turned around to face the other side of the road and let out a low growl. Soon after, all of the elephants became more active, pushing eachother back and forth in the road. To our right we heard the loud, continuous trumpeting of another elephant and crashing trees, which was quickly getting louder and closer. Several other elephants had squared off in front of us with ears flapping, pawing at the dust, and were beginning to approach. I looked in the rearview to see that the other cars were backing up, put ours in reverse and we got out. It was a close call, an idiot tourist move, but kind of awesome. On the picasa video, you can hear the elephant trumpeting angrily in the backround, a pretty disconcerting sound at the time (complements to Val for having the presence of mind to record it). The rest of our time in the park was more sedate, but we were lucky enough to see a leopard, an apparently rare encounter.


On Sunday, we drove east of the park to St. Lucia, on the coast of the Indian Ocean, where we took a riverboat tour to see crocodiles and hippos- from a safe distance of course. It was an incredible weekend and evidently not typical in terms of our close and numerous encounters. So far, two weekends well spent.


For pics and video: picasaweb.google.com/latrem --> click on the hlue hlue link

Where I Stay

We can't help but delight in some of the differences between American and South African English. Here, the trunk of a car is called the boot and an impatient motorist will hoot at you if you're driving too slow. Our favorite by a longshot is the robot, aka traffic light, for its entertaining mental image, not to mention the irony of reserving the name for such a simple and ubiquitous technology (how about the computer?).

On the way back from the wedding on Sunday we made a couple stops to drop off some friends, and as they directed us to their homes they would say "I stay on this street" or "I stay with Zinhle." I thought it a strange expression for permanent residents of Pietermaritzburgh but brushed it off as another South African idiosyncrasy. As it turns out, more than a semantic quirk, the term speaks volumes about the meaning of home in our largely Zulu patient population. For me, New York City is home (for the last three years), Long Island and Upstate NY before that and so on. Most of us can identify with having a "home town" where we grew up, but Americans tend to designate the place they presently live as home, or at least allow it as one of several places to call home. Even here, Val and I were calling our accomodations in Pietermaritzburg "home" within a day of arriving (on vacation, the hotel is home- ever catch yourself saying that?).

On rounds, Val was seeing a patient with one of the attending physicians (called consultants here), and they ran into some trouble clarifying the patient's social situation. When asked where he lived, the patient gave the name of a rural spot that didn't make sense in the context of ending up at Edendale. They asked several times, but only got the answer they were looking for when the question was posed as "where do you sleep at night?". This is apparently not an uncommon misunderstanding. It illustrated for us the ties that our Zulu patients feel with the land and culture of their upbringing. Especially after being welcomed into some Zulu rites and catching a glimpse of the breathtaking countryside over the weekend, I could certainly undersand where that feeling originates. I also couldn't help but feel a sense of loss when contrasting that bond with our own ties, which seem to be loosening account of our nomadic lifestyles.

Deli and Sfiso: An African Wedding

We were fortunate enough to get invited to the wedding of one of the iTEACH staff on our second day here. I will explain more in a future post about iTEACH, but it’s the TB/HIV program within Edendale hospital that hosts us. We were actually invited by other guests and didn’t even meet the bride and groom until the wedding day! We were a little hesitant to accept at first because we did not want to feel like we were imposing, but we were reassured several times that we were more than welcome.

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We drove down to Port Shepstone, which is on the South Coast, with several other iTEACH staff members as well as 2 other rotating Americans working at Edendale through iTEACH. It was an amazing drive with views of the Indian Ocean to the east and rolling hills spotted with huts to the west.

Saturday was the “western” wedding. It was in a church in the rural village where the groom had grown up. The drive to the church involved winding through hills along a dirt road and even more incredible views. Here, we learned our first lesson in South African culture…. nothing starts on time. We were almost 2 hours late to the church (we didn’t expect such a long trek) and still had to wait for the ceremony to start. The wedding ceremony was a typical Christian wedding (from what I could gather since the ceremony was in Zulu), although a noticeable difference was that the bridal party dances down the aisle and the guests are much more vocal during the procession of the bridal party. The reception that followed was also very similar to weddings I’ve attended in the Unites States, with an MC, speeches (including the requisite “drunk guy” speech), cutting of the wedding cake, throwing of the bouquet and garter. We met the bride, Deli, at the reception and her warm welcome made us feel completely at ease about being wedding crashers. The reception ended with a “braai” (barbecue) of beef from a cow that is sacrificed as part of tradition and, of course, with dancing (including traditional Zulu singing and dancing as well as the electric slide).

The party then moved to the groom’s house for the “umgudlo”, the traditional overnight celebration, where people dance and drink all night before the “umabo”, the traditional Zulu ceremony. We wore traditional Zulu outfits to the ceremony. The umabo begins with the

exchange of many gifts. The bride’s family must give the groom’s family several cattle (or the cash equivalent), depending on the bride’s “worth”. After the gift exchange, the bride and groom process separately with their respective guests following. They end up in a hut with the women and men on opposite sides. Deli wore an apron, swept the floor of the hut, then, on her knees, served Sfiso Zulu beer (made with water, yeast, millet seeds – tangy!), which she ended up spilling all over him! The food was abundant –men served first, sitting in chairs, women on the floor on mats. The meal is followed by another braii with beef and “jeqe” (steamed bread).

At the end of the ceremony, Deli was saying goodbye to some of her family members, but was called away by members of Sfiso’s family, which seemed strange. It was later explained to me that after a woman is married, she must give up being a part of her own family as she is now solely part of her husband’s family (some even go to the extreme of no longer allowing the bride to speak to her own family).
The wedding was an amazing experience not only because we were able to live first-hand the life and traditions of South African culture, but also because we were so warmly welcomed to do so. We felt really lucky to have been able to share in this celebration. (I also felt really lucky to have survived the ride home since cows come out of nowhere on the road and Mike seems to have a blind eye for cattle).

For more pictures, go to: http://picasaweb.google.com/latrem/WeddingPortShepstone# (Valerie’s pictures to follow)

RVD

Today was our first real day at work here. In some ways, we felt right at home (our first task was to draw blood on a number of patients on one of the medical wards). In others, the differences were striking. For example, we are accustomed to seeing HTN and DM (hypertension and diabetes) as nearly ubiquitous in patient problem lists. Here, we instead saw RVD, which we quickly learned stands for "retroviral disease". It took us about 30 minutes to have a sense of surprise when we came across a chart with the comment "RVD negative". Even in those who don't have RVD, it's placed on the problem list on admission as something to rule in or out.

To put things in perspective, here are some statistics on the state of the HIV epidemic in South Africa:

In 2007 there were an estimated 5.7 Million people in South Africa infected with HIV with 350,000 deaths attributed to HIV. The prevalence in South African adults in '07 was 18.1%, the 5th highest in the world. The top 4 are all in sub-Saharan Africa as well. This number has grown incredibly in the last 10-15 years. In 1990, for example, there were an estimated 160,000 adults in South Africa infected with HIV (prevalence 0.8%). We're hoping to get a sense of what these numbers mean for people who live and work here.

Will post more soon.