Ketunuti Blog

Bangkok October 2008

2008-10-13T17:19:00.004-04:00

Bangkok traffic. On a good day.

Rama VIII Bridge

Chris with Singha beer, tom yam kung and baked calamari with *lots* of pepper. yum.

We drove past the parliament on the way to this restaurant and saw that the streets were still barricaded with tires and barbed wire in preparation for the protests. The Monday protests had been canceled to pay respect to the two people who died during the demonstrations last week (it was the day of their cremation). There is also rumor that the two factions may be reaching a compromise.

On, Jonny and I at a seafood restaurant

Bangkok October 2008

2008-10-11T15:25:00.010-04:00

Northern Russia from the plane

As I suffer from the inevitable jetlag that accompanies traveling, I feel inspired to update my blog at 3am. Since my last post, I have uprooted (once again) from Georgetown, Washington DC and replanted in Philadelphia. I'm now starting a residency in pediatrics at the Children's Hospital of Philadelphia (I just couldn't get enough of internship so I had to do another). This is hopefully the last move for at least 3 years, given that's how long it should take to finish a pediatrics residency.

The CHOP pediatrics program, aside from being one of the largest in the country (40 something residents per year), is an incredibly supportive program. People are rooting for my success and education, which is a very different vibe than at Georgetown. As sexy as it was to be a life-saving surgeon, I feel much better suited for pediatrics.

I'm now back home for the first time in over 3 years and Bangkok doesn't seem to have changed as much as I had expected. The taxis are a different color, the airport has free wifi and things are slightly more expensive, but the city still has the same sense of disarray with its millions of people and unstable government. I love being home!

Yesterday my mother and I headed to the Chachuchak market in search of home decor (my Philadelphia apartment still looks barren). The Chachuchak market is an enormous outdoor weekend market where, with a little determination and a lot of walking, *anything* can be found, from snakes, fish, dogs to antiques to American army surplus. At the end of our expedition we were walking on a side street as it was getting dark when my mother accidentally came head to head with a baby elephant walking in the opposite direction. She screamed in surprise while the elephant just kept on walking by... I would give the elephant the right of way any day.

My dad at a local coconut seller: 10 cents a coconut

Chinese restaurant lunch appetizers: jellyfish in the middle, pigs ears on the right, and "thousand year old eggs" (the blue things). The eggs really did taste like they were rather old. Eating the jellyfish, I felt a vengeful satisfaction- I still harbor a grudge against the jellyfish that stung me some 20 years ago and left a scar.

I was reading the newspaper this morning and on the front page just beneath the headline highlighting government problems "PAD Leaders Surrender", I found these advertisements:

USA = Foodland. There's something seriously wrong with this perception, given that over 50% of the US population suffers from obesity.

Bangkok: the capital of sex change operations. Cheap too! I'm wondering why "orchiectomy" is crossed off though...?

And then on the side of the front page, a blurb about lizards: "Wildlife officials believe monitor lizards, seized in the Northeast, were destined for dining tables in neighboring countries".

Surgery Roast May 2008

2008-10-11T15:02:00.005-04:00

As I was downloading pictures from my vacation I came across these ones from our May 2008 Georgetown Surgery Roast!

Krit and Aimee

Babushkina and I

Kiran, one of our chiefs, once again spoon, er..., hand feeding Alex??

Washington DC Spring

2008-04-18T20:28:00.006-04:00

These pictures were taken in the late afternoon sunlight so they are a bit dim, but the flowers are still fun to photograph.

Tulips

A goose at the reservoir

Surgery Alumni Dinner!

2008-04-12T22:49:00.006-04:00

From right to left: Neda, me, Liz's boyfriend, Liz, Tim, Tim's wife, Alli's date

Aimee the star chief!

Neda and I pre-dinner

Alli, looking amazing, and me!

Who, me?

Alli, Drs. Chahine, Mark

Alex and Arun

Awwww....how cute! Neda and Alex!

April 11, 2008

2008-04-12T00:12:00.002-04:00

Quick Update

First, let me apologize for not keeping this blog up to date. I will once again try to keep it current.

News: I'm moving to Philadelphia to start my pediatrics residency program at the Children's Hospital of Philadelphia in June. Lots of new and exciting things to look forward to! Until then, I'm finishing up my surgery internship in Washington DC. Currently I'm working on the cardiothoracic surgery service at the VA hospital. The veterans are an interesting and surprisingly eclectic group.

Tonight, the surgery residents hosted a.... bowling party! I hit a high score of 78 (scoring *1* strike). More pics to come...

Finally getting around to seeing some DC sites!

2007-12-28T21:51:00.000-05:00

It's cold at the Lincoln Memorial! I couldn't quite appreciate it as I should have.

The Washington Monument

The World War II Memorial

Moving to Washington DC!

2007-06-19T22:20:00.000-04:00

Can you believe that this is the size of the truck that brought my little bit of furniture over from California! 18-wheeler

Graduation!! June 16th, 2007

2007-06-19T22:00:00.000-04:00

Some of us who have taken a little longer to finish than others. We're just well-rounded.

"I think this is the direction we're supposed to be walking..."

Finally the MD diploma! Half is for me, and the other half belongs to all those who supported me along the way! Thank you!!!

Washington DC: First Impressions (June 11, 2007)

2007-06-11T22:43:00.000-04:00

I've always thought of DC as the metropolitan capital of the US, swaying the decisions of the world, where important people schmooze with other important people. I was here 2 years ago taking part in a course at the NIH in preparation for a fellowship in Botswana, and now am back in a very different capacity, but exciting nonetheless.

After many delays at the Philly airport, arguing with an angry cab driver, and checking in to the wrong hotel, we finally arrived at our hotel in Georgetown. The weather is surprisingly pleasant, the people friendly and the shopping looks fabulous! My moving company has just called and informed me that my furniture will be a week late, and I can’t get a permit for my car yet. Somehow, this disorder adds to the excitement of starting a surgery internship. It reminds me of the chaos of moving to Botswana.

I just read an article from the South African Aids Conference in Durban. There was a controversial discussion about instituting mandatory HIV testing. My first thought is that in the US, individual rights are central to the way its society functions, and that mandatory HIV testing would never happen. But then I wondered about the mandatory isolation of TB patients, and all of the alarm that was raised by the XDR TB infected man traveling. Personally, I feel that mandatory HIV testing is an excellent idea if implemented carefully. Measures to protect those who are found to be HIV positive are essential; there is still so much stigma associated with HIV that this is issue that has to be thought about carefully. But health-wise and economically, mandatory testing seems advantageous. Most children in the US require immunizations to attend school- why not implement other protective measures in areas with a high incidence of HIV?

Northern California Coast (June 6-8 2007)

2007-06-11T20:55:00.000-04:00

"Rear View of the Golden Gate" (it's been looked at from so many angles, why not this one?)

Sea Lions at Pier 39 in San Francisco

The Transamerica Building in SF

Point Reyes, Northern California Coast

Mouth of the Russian river draining into the Pacific Ocean

San Francisco (June, 2007)

2007-06-05T22:21:00.001-04:00

April 2007: Muir woods

April 2007: The Golden Gate bridge

Bay to Breakers! May 2007: my mother and I ran the entire way (well, almost) and saw some amazing costumes, as well as no costumes... Great race!

Binche, Belgium (Jan 1, 2007)

2007-01-03T11:56:00.000-05:00

*2007*
HAPPY NEW YEAR!!! May the next be even better than the last.

Part of the Church in Binche, my home town in Belgium.

The rest of the church.

The walls (les ramparts) that surround the old part of Binche were built in the 1500s (I think) when Marie of Hungarie was living in the castle here.

My mother's old elementary school. She was, at the time, the only girl attending an all-boys school. Here, she perfected her shin kicks and punches!

A statue of the Gille de Binche- the town's claim to fame. People dress as Gilles with ostrich feather hats and a bucket of blood oranges during the carnival after Mardis Gras.

Mons, Belgium (Dec 29, 2006)

2006-12-29T11:16:00.000-05:00

Photos from Mons, Belgium:

One of the many pub signs

"La Place"

The Mons Collegiale

Christmas in Belgium (Dec 27, 2006)

2006-12-27T17:56:00.000-05:00

It's been a while since I've signed in, but it's been a busy 6 months, so I'm just going to pick up from here. In short, since returning from Botswana, I've survived...an ob/gyn clerkship, 4 sub-internships in surgery and plastic surgery, including one at NYU and one at Johns Hopkins, and half of my residency interviews. Now I'm finally on vacation in Belgium visiting my parents- we're extremely busy celebrating the festivities with lots of holiday feasts, shopping, and television (all important pastimes to catch up with!).

Below are some pictures of our visit to Lille, France today:

In front of the Lille Square

The Cathedral of Tournai by Night

Dog pics

2006-05-29T21:41:00.000-04:00

Gaborone Life (May 18th, 2006)

2006-05-18T07:12:00.000-04:00

Defining Quotes (May 18th, 2006)

2006-05-18T07:11:00.000-04:00

"Never be bullied into silence. Never allow yourself to be made a victim. Accept no one's definition of your life; define yourself."– Harvey Fierstein

"A mistake is simply another way of doing things."– Katharine Graham

Botswana Life (May 13th)

2006-05-17T04:11:00.000-04:00

Mountain Rest: An outdoor braai restaurant in Gabane. Meet is grilled and eaten with your hands- the tastiest way to eat.
Even the donkeys are laid back and enjoying a relaxed life!

Botswana can recycling.

Botswana goats. Some of the wisest on the planet.

Climbing Kgale Hill, Gaborone (May 7, 2006)

2006-05-15T14:06:00.000-04:00

Climbing at Kgale Hill in Gaborone, Botswana, with the baboons.

Sara looking very professional with her climbing rope.

And Linda showing everyone how it's done!

I'm barely getting off the ground here...

but am doing a little better here! This is when Sara told me to hug the rock like it was Pierce Brosnan. Well, it worked!

View of Gaborone and the dam

Fun Quotes!

2006-05-05T10:19:00.000-04:00

"It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something."– Franklin D. Roosevelt

"I searched through rebellion, drugs, diet, mysticism, religion, intellectualism, and much more, only to find that truth is basically simple and feels good, clear and right." – Armando "Chick" Corea

"It's not what you are, but what you don't become that hurts." - Oscar Levant

"Defensive strategy never has produced ultimate victory." – General Douglas MacArthur

"I think the purpose of life is to be useful, to be responsible, to be honorable, to be compassionate. It is, after all, to matter: to count, to stand for something, to have made some difference that you lived at all."– Leo Rosten

"Great minds have purposes, little minds have wishes."– Washington Irving

"Consistency is only a paste jewel that cheap men cherish." – William Allen White

Gaborone, Botswana

2006-05-04T09:41:00.000-04:00

Old Naledi: A poorer area of Gaborone where many temporary immigrant workers come to stay. Our study screens patients from the local clinic here.
I have no idea what service this shop offers!?! Recharges dead car batteries? Legal counsel for spousal battery?

Livingstone, Zambia (April 21-23)

2006-05-04T08:41:00.000-04:00

The Zambezi River crossing from Botswana to Zambia. To get to Livingstone, I flew into Kasane (Botswana), bussed it to the border (about 25 minutes), caught a ferry to across the river from Botswana to Zambia, and then got transport to Livingstone (about 50 minutes).

Medical students on safari in Africa! This picture was taken as we were doing a walking safari at one of the game parks in Zambia. We saw tons of animals, including giraffe, an enormous herd of trumpeting elephants, zebras, antelopes, gigantic spiders, and lots of birds. From left to right: Brent, Becky, Lyen, Arghavan, me, Tina. Becky and Lyen are medical students at Stanford now working on their masters in public health at the University of Cape Town. Brent and Arghavan are medical students at Stanford and will be going into medicine at UCSF and surgery at Stanford for their residencies next year. Tina is a medical student and will be going to Chicago to do her medical residency in medicine next year. And me, well, I'm just a lost soul in Botswana.

Harare, Zimbabwe (March 3-9, 2006)

2006-05-03T03:35:00.000-04:00

I know it’s been a long time since the last update, but here are some pictures of the most recent adventures!

A view from the castle in the Eastern Highlands of Zimbabwe. The castle, which is now a hotel run by two Portuguese, was built by Italian prisoners during WWII. With the mist, cold, and eirriness of the Eastern Highlands, it was just like Europe, which is probably why the prisoners built a castle here. We had a hectic time arriving at the castle, including getting lost at what looked like a military camp, almost driving off the cliff of the mountains in the dark, and having to veer around a toppled tree blocking the road.

The stairwell of the castle.

The Actor: A favorite Korean restaurant in Harare run by, believe it or not, an actor who lines the walls of the restaurant with his posters.

Seble and Bryan in the lab at the medical school.

The Harare Medical School. From left to right: Seble (Stanford ID Fellow), me, Bryan (Fullbright Fellow in Harare), and Esther (Fullbright Fellow in Botswana).

Zimbabwean food, which is like Batswana food but with peanuts added.

Some old car at the aforementioned creepy castle.

HAPPY VALENTINE'S! (Feb 14, 2006)

2006-02-14T03:20:00.000-05:00

"We taste and feel and see the truth. We do not reason ourselves into it."

– William Butler Yeats

Mozambique Trip! (Feb 3-6, 2006)

2006-02-12T03:14:00.000-05:00

The fish I caught (and by “I”, I mean me plus 3 other people pulling on the rod) from deep sea fishing in a channel off the coast of Pemba in northern Mozambique. These are two King Fish (8kg and 5kg). We hooked another 3 which got away (and the one that got away was of course enormous - it must have been as it broke the 100kg line!). Crew from left to right: Paolo (skipper), Chris, Me, John (fisherman who set up the rods and pulled hardest).

Mozambique girl on Ibo Island, an old trading and slave post. Ibo is still inhabited by locals but much of it is a ghost town, with old colonial building broken down with trees growing through the walls. Amazing island.

Mangrove Kingfisher, apparently a rare species.

News Articles (Feb 11, 2006)

2006-02-11T13:11:00.000-05:00

1. AIDS in the news
Researchers presenting at the 2006 CROI conference found that the earlier treatment is initiated, the slower a patient progresses to AIDS and the fewer side effects they have. The article mentions that there were significantly fewer side effects for patients who were started on ARVs at a CD4+ cell count of 350 or higher. The researchers attribute this difference to decreased inflammation in patients with higher CD4+ cell counts. “This suggests there is no reason to delay HAART treatment, and no reason to delay getting tested for HIV”, Lichtenstein (the researcher) said. Tshedimoso’s got it right!

2. Stanford in the news
Tiny Woman Gives Birth to Healthy Son
In brief, a 37 lb woman suffering from Type 3 osteogenesis imperfecta gave birth to a normal baby, at the Lucile Packard Children’s Hospital at Stanford.

3. Thailand in the Torino Winter Olympics
Our single contender, Prawat Nagvajara, is 46 years old and will again be participating in the Men’s 15km Classic Cross-Country Skiing event! We wish you well.

Safety and Music in Botswana (Jan 27, 2006)

2006-01-27T08:46:00.000-05:00

Who knew that Batswana crowds could be so dangerous! Now I don’t think I will ever be able to dance again with crowds for fear of being attacked. My dancing certainly could use some improvement, but still…

Why Was Vee Assaulted?

Mmegi/The Reporter (Gaborone)
January 12, 2006 Posted to the web January 12, 2006
Ephraim Keoreng

In what seems to be an increasingly growing culture of hooliganism, artistes are being harassed and sometimes beaten up at shows. On the last weekend of the year, Botswana's loved Kwaito sensation, Odirile "Vee" Sento, was beaten up at a show in Kasane.

The ever-hyper muso was scheduled to play at the show alongside Chilly Segona - a newcomer in the music industry - and Cultural Spears, a three member group, which is quickly endearing itself to the hearts of music fanatics. Vee's manager, Zenzele Hirchfield said that she was shocked by the gang who mobilised the crowd to beat up the House-Kwaito star.

"It was quite clear that other artists would open up the stage and Vee would perform later. In all the shows we have been staging, there have never been any complaints regarding this. But what happened in Kasane is something beyond my comprehension. You could see that something was wrong. The crowd, influenced by a group of men, harassed artistes who were supposed to warm up the stage for Vee," she said. Though she was not sure of the real cause of the disorder, she pointed an accusing finger at the organiser of the event whom she said has never organised a show before. She said he failed to foresee the disaster or even guard against it by hiring a sizeable security team.

"They were not able to contain the mob and later the crowd who had gone on a murderous frenzy," she said. Hirchfield says that it was a pity that unscrupulous characters masquerading as promoters and organisers, only to spoil the shows, are infiltrating the music industry. "These fly by night organisers pose a serious threat to the industry. Out to make a quick buck, they fail to fulfil requirements such as security and other measures needed to ensure successful shows.

Tshedimoso Update (Jan 25, 2006)

2006-01-26T04:49:00.000-05:00

"Tshedimoso" means "knew knowledge" in Setswana, the local language. Since I haven't had much time to post anything new on my blog, I'm instead posting a newspaper article that I've submitted to the Gazette, a local newspaper, for patient recruitment and education. It may be interesting to get an idea of what our study is working on:

The “Tshedimoso” Study: What You Should Know About Early HIV Infection

Where does the HIV epidemic come from? Botswana has the second highest HIV prevalence in the world, and almost 1 in 3 adults (19-45 years of age) are HIV positive. So how is HIV being transmitted so quickly? Research shows that the vast majority of HIV transmissions propelling the epidemic occur in the early stages of HIV infection.

If someone was infected with HIV just last month, the chance of them transmitting HIV to their partners is extremely high- possibly 20 times higher than normal. Early HIV infection is a very dangerous time for spreading the disease but very few people are aware of their HIV status during that time. If you have been recently exposed, it can be frightening to test for HIV. However, knowing your HIV status early is crucial to your health and the health of others.

If you have had a recent accident/unprotected sex, it is critical to know your HIV status as soon as possible, because during early HIV infection it is very easy for you to pass on HIV. Once you know your status, you are empowered to control your actions and to protect your loved ones from getting infected.

The “Tshedimoso” study (Botswana-Harvard School of Public Health AIDS Initiative Partnership) is trying to understand what goes on in the body during early HIV infection. The “Tshedimoso” study offers an HIV test for early HIV infection that lets you know your status sooner than with a regular test for HIV antibodies (the rapid ELISA): No more HIV “window period”.

As part of the HIV testing that “Tshedimoso” provides, the study offers early HIV education, supportive counseling, and empowerment for behavioral changes. This could help to stop the spread of HIV during this critical phase. The knowledge gained from the “Tshedimoso” study will help to design future HIV interventions, such as vaccines and treatments.

People who are newly infected with HIV sometimes experience “flu-like” symptoms such as headaches, body aches, fevers, or fatigue. Not everyone with these symptoms has HIV.

Are you worried about an early HIV infection? You can call or visit the “Tshedimoso” study clinic at 3930036/3931146/72747293 or visit the study clinic in the caravans at the Princess Marina Hospital behind the Old Dental clinic. The “Tshedimoso” study is also testing at the Old Naledi Clinic, Block 9, and the Gaborone Tebelopele. The “Tshedimoso” study clinic can help you know your status early and counsel you about what you can do to protect yourself and those around you.

Thought of the Day

2006-01-20T09:03:00.000-05:00

"The one important thing I have learned over the years is the difference between taking one's work seriously and taking one's self seriously. The first is imperative, the second is disastrous."
– Margot Fonteyn

Dec 18,2005

2005-12-17T09:51:00.000-05:00

I will be on leave for the next 3 weeks, but I will have plenty of updates upon my return…

HAPPY NEW YEAR!!!
May the New Year bring happiness, health, innovation, and optimism to all!

BHP End of Year Party (Dec 10)

2005-12-17T09:27:00.000-05:00

Lots of food, people, music. What more can you ask for?

Traditional Batswana food

Tug of War

Eric, head of the data management center and "heavy-weight anchor" for the tug of war.

Harvard Visit (Dec 5-9)

2005-12-17T09:19:00.000-05:00

Tshedimoso Team (from left to right) Florence, Kenneth, Busi, Charlotte, Rabya, Erin, Skhatele, Melissa (me), Phana.
MIA: Vladimir, Elias, Lemme, Eric

Zanzibar Vacation Continued...(Nov 25-29)

2005-12-12T09:22:00.000-05:00

"Once we believe in ourselves, we can risk curiosity, wonder, spontaneous delight, or any experience that reveals the human spirit."
– E. E. Cummings

The one thing I’ve learned from creating a blog is that, with the exception of my Dad, no one reads the text. And although I’m channeling my efforts in that direction, I can’t help but write a little bit about Zanzibar…

Zanzibar, Tanzania: Zanzibar comprises of a pair of small tropical islands (Pemba and Zanzibar or “Unguja”) just north of Dar el Salaam with about 800,000 people. Zanzibar, also known as the spice island, lies off the coast of Tanzania in the Indian Ocean. It’s famous for once being the commercial centre of East Africa and the last place to abolish the slave trade. Apparently, they are also renown for their door architecture, with the left side of the door representing a woman and the right the man- this confused Esther and I immensely as we weren’t sure which side was left or right, depending on whether one stands facing the door or walking out the door. But I digress. Zanzibar’s main industries are spices, tourism, and it is the only home of the Zanzibar Red Colobus monkeys (which we didn’t see because we were late for the plane). To summarize, it’s a beautiful, green place that’s definitely worth a visit!

The fisherman who sold us our lunch (fish and calamari).

The fish from the nets.

Zanzibar (Nov 25-29)

2005-12-11T09:15:00.000-05:00

What is this spice? Answer at the bottom.*

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Zanzibari sunset

Esther before the seasickness set in.

The fish we...bought from the fisherman (because we didn't satch anything deep sea fishing).

Fishermen with their catch early in the morning.

An enormous Manta Ray caught in a fishing net. Apparently they can be tasty when salted and dried.

Esther and I in snorkeling gear- ready to be fed to the sharks!

This is a coffee bean!

"Look at me- I'm an endangered turlte!"

*Nutmeg! The waxy red stuff is removed and the nutmeg is underneath.
More to come…

Loy Kratong or the "Festival of Light" (Nov 20)

2005-11-20T14:48:00.000-05:00

Loy Kratong is on the full moon night of the twelfth lunar month. The festival expresses gratitude to the goddess of water “Phra Mae Kongka”. The best part is making the kratongs, traditionally made of banana leaves and trunks with candles. Some pictures of my Dad and family celebrating Loy Kratong 2005:

The Ketunuti’s celebrating a Loy Kratong dinner outside our house. My Dad is in the red shirt looking content!

Kratongs (the little lit floats) in the backyard pond.

Some Fun Gaborone Pictures (Nov 17)

2005-11-17T01:11:00.000-05:00

Elephants really do hold each others tails!!

Monkey Business

Impala in the dust.

Tshedimoso Acute Infection Study (Nov 15)

2005-11-15T07:10:00.000-05:00

Impressions

First, frustrations, as today is that kind of day: I spend hours waiting for clients who don’t show up, and when they do, there are only about 1/100 (literally) who qualify for our study. Also, we don’t have a lab director anymore. Our study PI, has become the contact person for any lab related issues. And although he is extremely helpful, he’s not here in person, and there isn’t quite the direction that a high functioning lab should have. Some people in the lab (I won’t say who) joked that we would get a director quickly if we started asking questions like:

”Do we ship samples on dry ice or regular ice?”
“When we pipette, should we press all the way down, or just halfway?”
“What’s a mole?”
“What’s wrong with using distilled water instead of dH₂O?”

I joke about this, but some of these questions are not too far off from ones I’ve asked.

Positives (because what’s life without being a little optimistic): There is an increase in enrollment! People are starting to walk into the research clinic now that we’re distributing posters and business cards. Slow but steady progress is still progress. I’ve also started thinking more about lab projects, which I’m looking forward to, as I feel that I will have more control of things.

I’ve realized that I haven’t described what research I’m doing in Botswana, so I’ve included a little about our acute infection study below. I admit that I cheated a little and cut and paste this from our introduction letter, but it gets to the point.

Tshedimoso: Early and Acute HIV-1C Infection in Botswana/Markers of Viral Set Point in Primary HIV-1C Infection.

Overview

The Tshedimoso study aims to research the body’s immune response and the viral dynamics during primary HIV infection. Primary HIV disease can behave very differently from chronic HIV infection and is likely to be a predictor of time to onset of AIDS. Understanding the body’s response to primary HIV infection could generate interventions to prevent progression to AIDS, such as early treatments and vaccine design.

The Tshedimoso Study screens for two components of primary infection:

(1) Acute HIV infection
(2) Early HIV infection.

Acute HIV Infection

Acute HIV infection, also known as the HIV “window period”, is a period of approximately 2-12 weeks when the patient has HIV but does not have detectable antibodies and tests negative with a regular ELISA rapid test. Using a specialized HIV RT-PCR test, the Tshedimoso Study can detect the HIV virus just a few days after infection. A benefit of this specialized test is that patients do not need to retest for HIV in 3 months to confirm a negative result.

During acute HIV infection patients are 10-20 times more likely to transmit HIV. Some research suggests that the HIV “window period” is responsible for much of the spread of the HIV epidemic. Knowing one’s HIV status during the “window period” empowers patients with knowledge that may alter their risk-taking behaviors, protecting family and the community.

Early HIV Infection

Patients with early infection test positive with the rapid test and have an HIV infection less than 6 months old. Early HIV infection can be detected using the detuned HIV EIA test.

Weekend in Joburg (Nov 5-6)

2005-11-07T08:28:00.000-05:00

Highlights of Joburg: The Old Mutual Soweto Race, rugby, green trees, shopping, and real Thai food!

Johannesburg: City lights with an overexposure

Rustenburg
Chris and I took a trip to Joburg this weekend which was, again, planned at the last minute because Chris got her visa late and I couldn’t find my resident’s permit. Because of the late start we made a stopover in Rustenburg, a mining town northwest of Johannesburg. There were some scenic, mountainous areas, and a nice “kloof”, which I think means cliff? We also saw the shadier parts of town when we got lost (as usual) in the industrial area at night.

Sandton Shopping
We finally made it to Sandton Saturday morning after passing through Hartebeesport, checked into the hotel and headed straight to the shops. After a 2 hour stint in the camera store, we took on the shoe stores and beauty product shops- it was quite the shopping marathon! However, I was reasonable and only took back 1 pair of shoes and a moisturizer- necessary things.

Rugby and Cancer Research
In the afternoon, Tonie and I met up and went to support cancer research- he shaved his head and I spray painted my hair blue! It was for a good cause…I also learned a little bit about rugby from watching the South Africa-Argentina game in a very smelly pub. Players are allowed to grab each others legs, ears, shirts- whatever it takes to get the ball. There are 15 players on each team, except when there’s a scrum, then there are only 8 players on each side. As far as I could tell, a scrum is when the players pile on top of each other. A very entertaining sport!

The 14th Anniversary of The People's Race: The Old Mutual Soweto Race
I dragged my poor mother at 5:30 in the morning to this race, and it was fantastic! There were hundreds- probably thousands- of runners and tons of atmosphere! There were singing groups, blaring radios, lots of cheers. I had someone yell at me, “Go Chinese runner!”, which sounded like pure encouragement, so I smiled and ran faster.

Time: 0:53hrs. Considering that there were some wicked hills, I had slept about 3 hours, had one more Savannah than I should have the night before, and missed breakfast, I thought it a decent time. The only disappointment was that the organizers ran out of shirts and there were practically riots because of it. Overall, brilliant race!

Runners on the Soweto Marathon Route (2003)

Winner of the Soweto Marathon Tsotang Maene (2005)

Runners on the Soweto 10km Route (2005)

Finished!

Ishmael Khosie: I still haven't been able to figure out who he is...a runner or someone supporting the anti-apartheid movement?

Soweto: We ran past this!

Gaborone Half Marathon (Oct 30)

2005-11-07T07:20:00.000-05:00

The Running Club organized a fantastic half-marathon for about 100 runners that started at Game City and went for 2 loops around the area. The race, which started only 15 minutes late, was a very flat, fast course, with only a little bit of off-road running and lots of water stops. The only obstacle was a cow blocking one of the dirt paths, but nobody could have done about that as the cows and goats have free reign of the Botswana streets. Although there were some speedy runners there from Zim and SA, the winners were Batswana! Go Botswana! Tiyapo Mosa was also there, placing 8^th for men overall. The women’s winning time was 82 minutes (I’m unsure of the men’s time). My time was 114 minutes- not anywhere near the winner, but I was fairly happy with the run.

There were at least a dozen runners without shoes, who would really appreciate an old pair of shoes, as the roads had glass, sharp rocks, and are really hot. I gave an old, muddy pair away and they were very much appreciated. If you have old sports shoes (they don’t have to be running shoes- some people were running in Keds), please send them to the following address and I will get them to the running club: Attn: Melissa Ketunuti, Private Bag 320, Gaborone, Botswana.

I realize that this sounds like a scam, but what am I going to do with a pile of old running shoes?

Main Mall Health Fair (Oct 28)

2005-11-07T06:12:00.000-05:00

Although it had primarily a religious focus, the Health Fair on Friday addressing HIV stigma was productive. There were people screened for elevated blood pressure and diabetes, and of course lots of HIV education. BHP was represented by Reverend Hambira, who is our marketing director and an amazing speaker. I think appeals to people by talking about HIV research like he talks at a sermon! Overall, a success, with lots of business cards handed out as well as some TV time and a newspaper article. I am sure we will have patients lining up outside the study clinics asking to be screened by Tshedimoso…

My picture in the paper! Looking very busy....

Gaborone News (Oct 16)

2005-10-16T06:28:00.000-04:00

Newscafe: The only place in Gabs with free wireless connection! Very exciting for weekend outings, but I have become a little jittery with all the coffee I have to drink to stay here…

Immigration: Thursday I had to wait 3+ hours in line to renew my visa as I am still waiting for my work permit (which I may get by May). There were tensions as ‘consultants’ for Zimbabwean workers kept cutting in line. Surprisingly, it very much reminded me of when I was applying for my green card at the immigration offices in SF.

Timing: As I was reading Cully’s blog (sanbona.blogspot.com), I laughed as I could very much relate to his “Timing” entry. Here in Gaborone, there are only 3 times of day: in the morning, in the afternoon, and in the evening. I have made several attempts to ask for more specific times when scheduling appointments, and just ended up making people uncomfortable. When there are fixed appointments, one must keep in mind that 8am really means 8:30. Having said that though, the Harvard Institute is very much run American style- sometimes it’s quite difficult imposing this work ethic in Botswana, and has been the cause of some tension. But I feel that neither of these work ethics is bad, just different. And I really do appreciate a fixed lunch hour…

Work Update (Oct 12)

2005-10-13T01:09:00.000-04:00

The Tshedimoso Team has now been recruiting from Tebelopele, the voluntary testing center for over 2 weeks. The number of clients screened vary, with anywhere from 2 and 11 people daily. Although I believe that this is a prime center to recruit from, the numbers are disappointing, and it’s difficult to occupy oneself when there are no clients, especially with no internet access. So instead I’ve perfected my solitaire game, booked a vacation to Mozambique, and have read through all my chick magazines.

Okavango delta (Sept 28-Oct 2)

2005-10-05T03:10:00.000-04:00

The Okavango Delta from the plane

So close you can see the fly on the leopard’s coat!

Lion!

Lion sleeping.

Okavango Delta (Sept 28-Oct 2)

2005-10-04T01:26:00.000-04:00

A whole lot greener than Gabs! The best part: I get resident rates (>50% off).

Mombo Camp (Sept 28-Sept 30): Herds and herds of animals! This is an amazing camp situated on the northern part of Chief’s Island in the Moremi Game Reserve. Chris and I got lucky as two people canceled at the last minute, and as the rest of the camp was a group, we also got a private guide. Highlights: Tracking a leopard for 2 hours during the morning hours as it marked its territory, photographing a pride of 19 lions with their cubs, lunch next to the hippo pool, a lion hunt, elephants outside our balcony, an exceptional guide, and the outdoor shower.

Vumbura Plains Camp (Sept 30-Oct 2): Not as much game here but the camp has an excellent pastry chef. Highlights: A relaxing boat ride along the channels of the Delta, a pride of lions post-hunt, a walk through the African brush, a baboon lounging on our outdoor couch, and of course the warthogs running with their tails up (my favorite!). Also memorable was when we forgot our passports, wallets, and plane tickets in the room safe and had to make Air Botswana wait while someone sped back to camp to get them.

Hippo!

Baobab: note the size of the person in front!

A young male leopard marking its territory

Learning to drive a monster of a 4x4

Botswana Update (Sept 26)

2005-10-04T01:23:00.000-04:00

Kgale Hill 4 km and 10 km (Sept 17-18): 4km up Kgale Hill on Saturday afternoon (which was brutal in the heat!) and a 10 km flat race at 7am the next morning. There was prize money, so runners came from all over- Francistown, Zimbabwe, Gaborone. Amazing runners and too much competition! Baboons and cows were our only spectators along the very dusty roads. Several runners ran either barefoot or with duct tape around their socks (and I don’t think this was because of the new running-without-shoes trend), and several of them placed. I felt a little ashamed with my Asics running shoes and gear. Highlight: meeting Tiyapo Mosa, who was the Botswana representative in the Sydney Olympics marathon! He had led the marathon until the halfway mark when he fell behind. In Kgale Hill race he placed in the top 10, but said that he wasn’t in top form these days.

Chris ran the 10 km and had a strong finish with many cheers and a congratulations from Tiyapo!

Of note: Esther and I (and the other people who placed in the FNB 15km race 4 weeks ago) got our picture in the Sunday Standard newspaper!

Mokolodi Cheetah visit (Sept 25) We went for a quick cheetah visit at the Mokolodi Game Reserve. It made me a little nervous when the cheetah decided to grab my leg and wouldn’t let go for about 10 seconds. Kind of like a cat would do, but a cheetah.

Work (Sept 27): The Tshedimoso Study has started recruiting at Tebelopele, the voluntary HIV testing center in Gabs. Our first week has had variable results, with anywhere between 1-10 patients screened per day. Some of the variation does have to do with the upcoming long weekend (Independence Day September 30).

All of the recruiting material (business cards and posters) have finally been approved by IRB, so hopefully we will have something in hand within the next 2 weeks!

Lab-wise things are a little shaky. Some supplies (Superscript III RT enzyme, for example) have been known to take months to arrive. Currently, I’m spending very little time in lab, but it would be nice to get something started. The plan is to set up single genome sequencing and start by looking at the env and nef genes.

Funny moment: Driving to the Riverwalk Mall, there’s a traffic jam because a herd of cows is moseying across the road at a robot (traffic light). The dusty cows are blocking 2 brand new Mercedes, in front of a very modern mall, underneath an advertising TV screen. Quite a contrast! I’ll have to get a picture.

Dust storms (Sept 26-27): Dust everywhere. It was even difficult to see while driving.

Pooch

2005-09-14T15:34:00.000-04:00

I found these cute pictures of my Pooch!

Weekly Update (Sept 11-14)

2005-09-14T14:58:00.000-04:00

Sunday Service
Sunday morning, Chris, Sarah and I attended a local Episcopal church service. It’s ironic that it took coming all the way to Botswana to attend a service, as I’ve never in my life been. The church was located in a middle-class community on the west side of Gabs- a small yellow building with plastic chairs and an altar behind a low divider. The 30 or so church goers were most welcoming, sitting us in the very front row with our very own bibles and book of hymns. The service was even conducted in English for us, although everything was sung in Setswana. I needed help in finding passages as, again, I’ve never opened the Bible. My favorite sermon was when the preacher discussed the curse of the angels bringing a heat wave across the land, and “when this heat wave comes, there will be NO AIRCONDITIONING!”. It sounded very threatening. I had better be saved. Although I make no pretense of being religious, the atmosphere was so welcoming and provided such a nice feeling of togetherness that I think I would enjoy going to services just for the community bond. The atmosphere was, however, occasionally broken by a lizard scuttling in through the door and running across the carpet too close to my feet.

News Café
After the service, we headed over to News Café and discovered that the rumours of a free wireless connection were true! A very exiting day.

Driving Ticket
We were headed over to the Mokolodi Game Reserve to pet some cheetahs when I was asked to pull the car over because I supposedly didn’t stop at an obscure “STOP” sign that no one else was stopping at. The fine was P200, but we managed to bargain it down to P50:

Policeman: “P200 for passing the stop sign.” [big smile]
Us: “We only have P50 with us today.” [bigger smile]
Policeman: “What am I going to do with P50?” [slight look of concern]
Us: “Have a drink.”
Policeman: “A drink?” [thoughtful look] “Ok. I’ll go have a drink.” [Big smile and money placed in left pocket. We are waved on]

The cheetahs hardly looked like wild animals, but were so cute and purring!! They even rolled over and tried to play with the guide’s leg. Unfortunately, I'm having problems loading them, so I've instead put in a picture of a warthog!

Mountain Rest
Sunday evening, to give visitors Paul and Chris a taste of the ‘real Botswana’, a group of us drove over to jazz night Mountain Rest, an outdoor braai/restaurant in Gabane (recommended by Jose Hagan, Fogarty alumni). As a group of mostly Asian people, we received some stares and Ni Hao’s as we walked in. Unphased and smiling we bought our steaks, pap, and beer. We grilled the steaks on the braai outside and ate them standing up without utensils- really tough and really messy- I spent a long time flossing that evening. The atmosphere was lively with great music, and fantastic for my ego as I’ve never been asked for my phone number by so many people! It was quite the experience and I will have to go back during the day- I hear there’s a nice view there.

Gym Active
Gym Active is quite the highlight of my day. I love the aerobics classes with the techno 80s music and the mirrors that fog up from everyone sweating. Squash is also loads of fun- I almost won a game on Tuesday! I also accidentally threw my racket across the court…The running club, which the “President” has named “The Running Club Anyone Can Join”, does ~6k every Tuesday and Thursday. We also plan to join a race this weekend which is a 4k up Kgale Hill on Saturday afternoon and a 10k Sunday morning. T-shirts for everyone!

Work
Work-wise things are going well. Recruitment is slowly continuing, although Florence, one of the nurses, is sick this week. It really makes me notice how essential she is and how useless I feel in not being able to replace her. We are planning on starting to recruit from Tebelopele, a voluntary HIV testing center which sees 70 patients a day- 70 patients! I’m salivating. I’ve also started giving out sweets to physicians and nurses who have to listen to my Acute/Early Infection Tshedimoso presentation, and I’ve found that suddenly people are much more enthusiastic about it. In fact, nurses even came to ask me specifically for a copy of my information sheet! I like to think it’s my tantalizing speeches and charismatic personality, but I do believe the sweets have something to do with it. Well, whatever it takes…

Lab-wise we are going to start sequencing env and nef on some practice samples, and setting up single genome sequencing (SGS). We have also ordered some PCR supplies- a small tube of Superscript III costs an arm and a leg and supposedly takes months to arrive. Still all very exciting!

Weekly Update (Sept 9)

2005-09-09T10:14:00.000-04:00

Residence Permit: This week I’ve been having some difficulty with obtaining my residence permit. It seems that even though I’m taking a leave of absence from medical school, I’m still considered a student and have to go through a much longer process to get a permit. The medical report I filled out is as follows:

I hereby certify that on [date] I examined [name] and found him/her to be not suffering from any of the disabilities referred to in Note 1:
(a) being an idiot
(b) being an imbecile
(c) being a feeble-minded person
(d) being an apileptic
(e) having had a previous attack of insanity
(f) suffering from constitutional psychopathic inferiority
(g) suffering from chronic alcoholism

I had to think about (c) for a while…

The headline for the Daily News today: “Council confiscates spoiled pasta”. Another notable article was from the newspaper Mmegi. One of the local chiefs was concerned that the labola, or bride price, was getting too expensive, and planned to restrict it to a maximum of six cows. Six cows!! I sometimes wonder how many cows I’d be worth. And would they be meat cows or milk cows…what about a goat?

Mashatu Game reserve (Sept 2-4)

2005-09-08T04:45:00.000-04:00

Mashatu Game Reserve is located about 5 hours northeast of here along the Botswana-South Africa-Zimbabwe borders. It's a beautiful lodge, but unfortunately the area is experiencing a drought. Except for flying car parts and not finding a gas station for a while (I learned that unleaded cars can, in fact, use leaded gas with no problem), our trip was relaxing.

The baboon outside our window.

The elephant highway.

The Lion

Our walking guide teaching us about rocks and baobab trees.

A graveyard. Each grave is marked with a little tent.

Mashatu Game Reserve (Sept 2-4)

2005-09-06T01:23:00.000-04:00

Mashatu Game Reserve is located about 5 hours northeast of here along the Botswana-South Africa-Zimbabwe borders. It's a beautiful lodge, but unfortunately the area is experiencing a drought. Exept for flying car parts and not finding a gas station for a while (I learned that unleaded cars can, in fact, use leaded gas with no problem), our trip was relaxing.

My favorite animal of all time- the warthog!

The everpresent livestock crossing the road. Almost as dangerous as the flying car parts.

A convenient means of transport. Written on the cart was "Nissan Herdyard"...

Chris the photographer.

The Mashatu tree (the only green tree now standing).

A Cactus

The Sunsets

Weekend Update (Aug 27-29)

2005-08-30T04:09:00.000-04:00

This past weekend embodied all things Botswana: the prize cows and goats at the Botswana International Trade Fair, the 10km race that was actually 15km, the combi ride to the wrong side of town, and the Lucky Dube concert that went on until 6am. It was a big weekend for us Batswana.

First National Bank “10km” Running Race
Esther and I entered what was supposed to be a 10k running race on Saturday morning at Game City (a shopping center). As the race was advertised to start at 6am, we were there promptly at 5:45 and, as always, were the first ones to arrive. It mystified me how everyone else running somehow knew that the race wasn’t going to start until 6:45 and arrived right on time. And of course, the race started while Esther and I were in the loo. Although slightly discouraged at the missed start, we quickly recovered our optimism and ran with fervor. We were again slightly discouraged when the 10km race turned out to be a 15k race. One of the organizers pointed out to us as we were running that more people join if a race is advertised as a 10km... Nevertheless, we ran on and managed to each win a cooler, a water bottle, and a cap, and got our picture taken with the First National Bank mascot!

The Botswana International Trade Fair
Later that day, my Mom and I headed over to this week’s attraction, the Botswana International Trade Fair, where I believe everyone in Gaborone had gathered.

One of the prize winning cows:

The Lucky Dube Concert
The Daily News advertised that Lucky Dube, an older South African reggae star, was playing at the Blue Tree, and that tickets were being sold at the trade fair. There were no tickets to be found, but, unphased, Esther, Erin and I headed to the Blue Tree at 7pm. When we arrived, we were lucky to find tickets. There was a remarkable negotiation where we paid across a chicken wire fence, stuck our hands though the chicken wire to get them stamped, and then got an extra arm stamp for the car. When we asked what time the concert was starting one of the 15 guards replied, “Just now, just now”. So we headed inside and, as always, we were the first ones there. After relaxing for an hour or so with drinks, pap, and seswa (a boiled, shredded meat dish), we realized that despite our obstinate waiting, the concert was not going to start for us. We went home with big plans to return around 11pm, because then, surely, the concert would be in full swing. Sadly, despite our best intentions to rally, we all fell asleep, completely dressed. However, I did hear practically the entire concert from my bedroom between 3-6am. It was, in fact, terrific reggae music!

Combis
The Sunday excitement was a combi ride (a public transport minibus) for 2 Pula (50 cents) to the Broadhurst Mall. Chris and I mistakenly jumped onto combi number 5 instead of combi number 1, but the driver took pity on us and dropped us off at the right place. At the Broadhurst Mall I strangely felt that I was blending in better than usual among the Chinese street vendors, and had a pang of homesickness.

When I first arrived in Gaborone I thought it so odd when people strolling down the street turned to me, with big smiles, to say “Ni Hao”- apparently this means “hello” in Chinese. Being half Thai and half Belgian, I don’t think I look at all Chinese. But then again, I can’t tell the difference between a Kenyan and a Matswana (a person from Botswana).

Work
A reader may think from my blog entries that I do no work, but my project team has in fact been making considerable strides. The study I’m working on is called “Tshedimoso” (pronounced tse-di-mo-so), which means “enlightenment” in Setswana- we truly have high expectations of our patients. The study is looking to enroll 100+ patients with acute (within 3 weeks) or recent (within 6 months) HIV infection. Patients will then be followed for 1 year with monthly blood draws, and their immune responses and viral diversity/evolution studied. Although there’s little incentive for patients to enroll, almost everyone who has qualified has enrolled. The study started about 10 months ago, but there are currently only 14 patients enrolled- acute/recent infections are just very difficult to identify. However, the new, larger Tshedimoso A-team (1 PI, 1 study physician, 2 nurses, 1 technician, 1 driver, and 4 Fogarty fellows) is set to “revive” this study, and our first and foremost job is to improve recruitment. So far, we’ve worked on advertising (posters, business cards, presentations, radio/newspaper ads etc), developing relationships with new recruitment sites, and concurrently the Fogarty fellows have been developing lab-based projects to analyze prospective samples. The work is sometimes slow, with long meetings, and meetings where no one shows up, but overall moving forward.

Sandboarding in Joburg (Aug 13-15)

2005-08-18T08:59:00.000-04:00

Esther, Erin and I made a last minute decision to go to Joburg to visit Sudeb for a ‘southern Africa Stanford reunion’ weekend. On the road to South Africa, we were stopped at a speed trap for going 80km/hr in a 60km/hr zone (which we weren’t) and asked to pay 400 Rand (which we didn’t have). Together we scrounged up 100 Rand, which didn’t cover the bribe, but was apparently enough for a real ticket. So we were sent down to the local police station and paid our ticket to a stunned policeman who I’m sure hadn’t dealt with a ticket in years. He couldn’t find the receipt book, wasn’t sure where the stamps were, and took a long, long time to write it. Not surprisingly, the other three cars that were stopped never showed up at the police station.

In Joburg, we got lost at the airport and our friends had to come pick us up from there. Then we spent several hours in the NICD lab drinking tea and encouraging Sudeb to finish his PCRs. When we had had enough tea, we drove ourselves to a restaurant for dinner and were promptly turned away because of dress code (we did look like tourists from the bush). We finally had dinner at around 10pm in Sandton and then felt too tired to do anything other than go to bed- things would be better in the morning. And they were, slightly. We joined a group of people to go sandboarding in a mine dump in Benoni (a suburb just east of Joburg) which was terrific! How many people can say they’ve been sandboarding on a mine dump! This is best described as a post-apocalyptic adventure a la Mad Max (as coined by Erin). Thanks to Eleanor for organizing and inviting us. Given the amount of sand that we took back with us (I found sand in my ears two days later!), it was reassuring to know that they do check the levels of dangerous chemicals every six months.

Sudeb looking slick as usual!

Group Photo

Esther tearing up the slope

Shayne the official photographer

On the way home, we got completely lost in the dark and kept circling the Cradle of Humankind- it was like a mysterious magnetic force that wouldn’t let us out of it’s grasp. Erin also saw a flying impala, which was in fact a “giant ass bat”. When we finally neared Botswana, we missed the border crossing and had to find a B&B to stay at overnight. Esther was also feeling sick. Then we locked the keys in the car at a gas station in Zeerust. We were quite the town attraction for about 30 min, with everyone coming to give advice and rigging tools to open the doors. There were cheers when someone opened a window after breaking off the sun shield, and we were able to crawl into bed. We crossed the border early the next morning (with the only annoyance being the customs official asking Erin to marry him) to make it back in time for an 8am lab meeting. In retrospect, it was clearly a dangerous and imprudent situation, but all things considered, I was exceedingly proud of the way the three of us were able to handle adversity and laugh at the situation (albeit a little hysterically).

Running in Gaborone (Aug 12)

2005-08-12T11:11:00.000-04:00

Running is possible in Gaborone, and fun! It's a little like cross-country running - avoiding combis, running in sand and dust, over broken sidewalks, getting lost. And except for the occasional speeding car, it’s been very safe. Chris (my Mom) is brave and goes running by herself at 5:30 in the morning! I don’t go until 6:15 when the first rays of sun come out. Apparently, though, there were several others out at 5:30. There was even a woman lying in the middle of the road - my mom first thought that she was injured and needed help, but it turned out that the woman was just doing her daily sit-ups in the middle of the road!

Gaborone City (Aug 11)

2005-08-12T07:44:00.000-04:00

Alright, Governor, you wanted pictures, here are pictures!

BHP Entrance

A Field

Princess Marina Hospital Entrance

The Mall

Weekend Activities (Aug 6-7)

2005-08-08T02:40:00.000-04:00

Otse Village: 45k south of Gaborone

Mokolodi Game Reserve: 15k south of Gaborone

I had my first Batswana braii on Saturday with many ex-pats and several locals, where we tasted the regional specialties of chakalaka, pap, and beef. It’s a little overwhelming to meet new people, in a new country, who are mostly ex-pats…but I maintain optimism.

Settling In (Aug 4)

2005-08-04T08:52:00.000-04:00

Entertainment seems somewhat limited in Gaborone, but a popular hangout seems to be the Palm casino, where I learned the first rules of blackjack (always double on an 11, unless the dealer has an ace; 16 is bad). No bets yet though.

I’ve also joined the Active gym and have been going to this surreal spin class. We jive to techno Paul Simon music and do half the class in the dark - very surreal at 6am. I definitely stuck out as the white person who was not keeping rhythm (“relax your shoulders...left-right-left-right”).

I now own bedsheets! Erin and I have been going to the Old Naledi and Block 9 clinics (suburbs are called "blocks", "extensions" or "phases"...one is also called "New Canada") in the morning to learn about the patient recruitment process for the acute infection study, but also to have a chance to interact with people. We ventured to the Main Mall today and lunched with enormous portions of pap, samp, beef stew, curry chicken, and 3 types of veggies- for $1.50 each!

Arriving to Gaborone (Aug 1)

2005-08-04T08:31:00.000-04:00

After dealing with airline strikes, a 12-hour layover in London, a lost boarding pass, belligerent passengers, and a 44 hr door-to-door travel time, it was an enormous relief to finally arrive at the (very small) Gaborone International Airport. Flying into the city, my first impression was that there were a lot of cows around the airport and not many buildings. Esther and Andy (my temporary roommates) let me park my bags in the apartment before driving me over to meet everyone at BHP and then to buy sheets and groceries- it was a relief to see a familiar Pick n’ Pay grocery store as well as a Woolworths! I have already received lots of advice on must see places and am planning all sorts of exciting trips- of course only after working long, hard hours. I was also surprised to find out how warm the winter is- it makes me wonder about the summer. This week will mostly be settling in, meeting people, and visiting the clinics before (hopefully) starting work next week.

Mountaineering on Mt.Shasta (July 23-24)

2005-08-04T08:01:00.000-04:00

Right after flying back from D.C., Geoff and I drove to Mt.Shasta to join a mountaineering trip. The first day, we hiked for about 4 hours to camp at 9,000 feet. On Sunday, we woke up at 1am, started hiking at 2 am, and finally reached the plateau of Mt.Shasta at noon…never again…although the views and glissading down the ice actually did made the climb worthwhile. And we learned something about ice axes, crampons, and roped climbing. My favorite moment was baring my rear end to all the climbers, because there’s really nowhere to hide on a mountainside full of snow.

Fogarty Course in Washington D.C. (July 5-22)

2005-07-19T22:31:00.000-04:00

The fellows have all gathered at the NIH for an ‘intense’ orientation before we head off to our respective sites. There are 27 US fellows (mostly medical students and several PhD students) and 27 very accomplished foreign fellows (mostly physicians). The course so far has included some big name speakers, which is exciting, but lacks a focus and is not necessarily structured as a preparatory course. It seems that the lecturers are directing their talks so that everyone can understand a little bit, which unfortunately leaves everyone feeling like they’ve only learned that little bit. However, it is a fantastic time to meet other people interested in international health and to find out how they’ve become involved. I’ve even met two other people who want to work internationally in surgery, which is thrilling as I didn’t think such people existed!

D.C. itself is vibrant with all the Mall museums, restaurants (I highly recommend fufu at the Ghana restaurant at Adam’s Morgan), clubs, and of course shopping (Filene’s Basement!). We even went kayaking on the Potomac River on Sunday- check out the picture of Gina and me cruising ahead and leaving everyone behind!

Good luck to all the fellows at their respective sites! Hopefully we will all come back having learned a little about clinical trials, science, a new culture, and a lot about ourselves. I don’t usually use quotes, but these are kind of fun:

A person is a success if they get up in the morning and gets to bed at night and in between does what he wants to do. ~Bob Dylan

Even if you are on the right track, you will get run over if you just sit there. ~Will Rogers

To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking. ~Goethe

Namibia links:

2005-07-16T14:57:00.000-04:00

For those of you who just can’t get enough of Namibia, or who are bored at work, please take a look at Chris’ superb website:

www.bochris.com

NYC 4th of July: Pam's bridal shower and bachelorette party!

2005-07-12T20:25:00.000-04:00

Pamela the gorgeous bride dancing the night away at culture club. Leah: the best toilet paper bride ever.
Arlene and I at the karaoke bar.Manisha looking cute as always.

Etosha National Park

2005-07-12T20:18:00.000-04:00

For Etosha National Park pictures, check out Chris’ website: www.bochris.com/Etocha.html

More Namibia pictures...

2005-07-12T18:24:00.000-04:00

Shadows of Chris and I projected onto rock art in Darmaland. Both of us, as always, with our cameras. Termite mounds (often incorrectly referred to as 'ant hills') at sunset near the Waterberg plateau. Sand dunes in Sossuvlei with a lone tree. Marlboro man.
Abandonned and stripped minibus in the middle of a desert somewhere.

Our broken plane in northern Namibia

2005-07-12T17:40:00.000-04:00

Our pilot unsuccessfully starting the propeller plane as curious kids wonder what these crazy people are doing. We ended up spending the night here.

The Ovahimba

2005-07-12T17:38:00.000-04:00

The Ovahimba people in northern Namibia.

The Ovahimba

2005-07-12T17:37:00.000-04:00

Update!

2005-07-12T15:26:00.000-04:00

Since my last posting, I’ve been to Cape Town, Namibia, back to California and am now in Washington D.C. In brief, I was at Jooste Hospital in Cape Town for a 4-week internal medicine clerkship. Unfortunately, I didn’t take pictures, but did learn lots about TB, HIV and, believe it or not, leptospirosis. Jooste Hospital is a secondary township hospital struggling with limited resources but with an amazing, dedicated staff and a very strict (but nonetheless amazing) director. Chris (my mother) and I made a last minute decision to take a 10 day self-drive trip through Namibia before returning to sunny Cali and packing up for a 3-week Fogarty course at the NIH in Bethesda. On the way, I stopped by NYC to see some wonderful college friends at Pam’s fabulous bridal shower and bachelorette party! I will then be heading to Gaborone, Botswana, for 10 months in August to work with the Botswana-Harvard Partnership (BHP) on a clinical trial looking at acute/primary HIV infection, and hope to keep everyone posted with the blog!

2005-05-03T00:38:00.000-04:00

Pirates Cove Trail Run: Golden Gate Bridge

Weekend Run

2005-04-01T01:59:00.000-05:00

Pirates Cove Pacific Coast Trail Run: 18.6 miles and 4000 ft elevation- 4:07 hrs of muddy, rocky hills and poorly indicated sign-posts. It's probably the most beautiful run that exists, with splendid views of the Pacific Ocean, the Bay, San Francisco and the Golden Gate bridge. Fortunately, the views are what I'm going to remember, but my shoes that used to be white and now are brown coated with mud and my still aching quads remind me that there was more to it than that! Despite the poor trail markings (which made me go about a 1/2 mile off course), I give Pacific Coast Trail Runs credit for their tasty salted potatoes and gummi bears at the aid stations- it was hard to tear myself away from the rest stops! This run will definitely be on the "to do" list for the future, when I'll have forgotten about the sinking mud, grueling hills, and disgusting bugs. Already almost a week has passed and I'm telling myself that really, it wasn't that bad. Sure, my foot got stuck in the mud and my socks were completely soaked, but how many people have actually looked *down* on the Golden Gate bridge?

2005-03-22T23:01:00.000-05:00

Grouch the cat.

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2005-03-22T22:59:00.000-05:00

Pooch the dog.

2005-03-22T00:46:00.000-05:00

First entry: Today was day 1 of Stanford plastic surgery. The 11 hour case (notice the singular of "case") was, needless to say, long, and I'm not convinced that it was particularly beneficial. However, I have high hopes for tomorrow.

In the news: This past saturdayGeoff, Ben and I ran "Romancing the Island", an envirosport (environment friendly, although not knee, hamstring, or quad friendly) race. For results, check out http://www.envirosports.com/events/displayevent.php?eventid=1296. Splendid views of SF and the bay, although the trails proved to be rather muddy andmostly uphill. As soon as I figure out how to post pictures, you will have a chance to see our muddy legs.

My plan is that this blog keep everyone updated on my adventures and wild escapades around the world, particularly when I head off to Gaborone, Botswana for 10 months starting this August. I'm sure it will also be an outlet to vent my discontent, so bear with me...