January 3, 2005

The pressure is getting to me.  Keeping these dispatches going assumes that the writing will get better and more compelling.  Alas!

We’re just coming out of the Christmas lull, when things slow way down here. The kids are midway through a 6 week break.  Despite the fact we made a concerted effort to play down Christmas, we still had a last minute guilt-frenzy.  This was no doubt a toned down season for sure (see our Charlie Brown tree under to the left).  At the end of the day, as they say here, we really had a good time and a very peaceful Christmas day. 

Work slowed down to a crawl for the 2 weeks before, and is now just starting to pick up again, albeit only slowly.  This is a sane pace, one that could take more than one summer here to get used to.

The days seem to alternate from still and hot to gale-force blustery.  The wind here is warm, and to me, not unsettling, like the wind in many windy places.  The wind here seems to have a purpose, whether it’s to clean up the pollution that comes from unchecked car spew and burning shacks on the Cape Flats (when the wind is called the “Cape Doctor”), or to fill some rich guy’s yacht’s sails, or to send a breeze through my bedroom at night, or to make it damn hard for any plants not belonging to the native fynbos to grow in such conditions.

Since early December, we’ve been planning either for the holiday or for our first, and possibly only, sojourn out of South Africa.  In two days we leave for Tanzania, in small part for me to attend a conference in Moshi at the Regional Dermatology Training Centre, but in larger part for us to go to Zanzibar and some of the national parks that makes East Africa so renowned.  Most of us envision this area when we think of savannahs populated with the large African animals we learn about before we can speak and generally only see in zoos.  This is Real Africa, most Capetonians say apologetically, referring to their city as some bastard child of a city, more European, than African.  If one hangs only in Constantia, Clifton, Camps Bay, and the City Bowl, this might be true, but even that doesn’t admit that this is all Africa, that this place encompasses a broad spectrum of nature, pop and native culture, colonialism.  Do hot, humid climate and free range elephants define the continent?

I am excited to be going to Wilder Africa, while there is still some semblance of its even wilder past.  Tanzania and Kenya have clearly been tourist and hunter destinations for a long time.  Fortunately now the camera has largely replaced the rifle, though big “game” areas still exist in Africa.  The Safari business is booming from what I see at this end of the planning.  Lots of companies are thriving in places like Arusha, the center of the “Northern Circuit”.  I’m glad that this wealth is getting spread out.  I’m a little worried about the prospect of being on the beaten track, though I’m prepared to give myself over to it.  I can’t afford not to.

Prior to Christmas, I visited Polokwane, renamed from Pietersburg, which is what most people still refer to the town as.  Here I made a stab at establishing a fourth teledermatology site.  In time I believe it will be successful.  Polokwane is the provincial capital of the most northern province of SA, Limpopo.  Despite its relative proximity to Johannesburg, Limpopo is fairly isolated health care-wise.  To help bridge the distances in this area, Polokwane Hospital has placed a high bet on telemedicine.  The vision of telemedicine serving Limpopo had a setback when the main proponent in Polokwane unfortunately passed away just before I went to visit.  Prior to Professor Molehe’s death, however, half a million US $’s were spent purchasing sophisticated telemedicine equipment, all of it still in boxes in the hospital.  This equipment is meant to serve several district hospitals, but unfortunately little training of providers at these sites has occurred.  It was also clear to me that some in the Polokwane Hospital were opposed to the approach taken in acquiring the equipment, so some underlying resentment over possibly wasted resources was brewing when I arrived there.  Just the mention of telemedicine caused some to bristle.

So in I come proposing to set up Polokwane as a referring site for teledermatology.  Since mine was a research protocol, I had to appear before the Limpopo Province Ethics Committee, despite that I had human subjects approval from UW and UCT.  I thought this would be a minor formality, with a rubber stamp approval.  Au contraire!  These folks were tough, though in retrospect, now that I understand the lay of the land better, I believe the Committee was interested in protecting the provincial resources, as well as the subjects of the study.  Who could blame them, when some yahoo with a foreign accent arrives, pitching some research that threatens to splash patients’ images all over Cyberspace and possibly blow more money down a perceived rat hole?

The second day in Polokwane a conference on telemedicine was held, in part to honor the late professor and in part to decide how to proceed from here.  I presented my proposal, and I believe it gave some credibility to telemedicine as a concrete tool, rather than some pie in the sky money waster.  The other plus was that my plan is CHEAP, and for now, almost without cost to Polokwane.  This didn’t solve the issue of how to use $½ million in equipment (which didn’t even include a digital camera), but the idea of someone doing something useful with ICT in healthcare in the province was a welcome sight.

By the second day’s end, a willing and capable point man came to the fore, and almost secretly, we made plans to get things going in teledermatology from Polokwane.  Ethics approval eventually came, though consent forms needed translation to a fourth official South African language (there are 11 total), Northern Sotho.

While in Polokwane/Pietersburg, I stayed at a terrific guesthouse called African Roots.  I also visited with the father of one of the UCT dermatology registrars, Hanif, who is from this area.  Mr. Omar was amazingly gracious to invite a perfect stranger into his home to meet his brothers.  His family is Muslim and has lived in Pietersburg for quite a while, witnessing the changes that have occurred before and after 1994.  The country is so new that most are still waiting to see what the impact of apartheid’s end and democratically-elected government will be.  Issues of race run deep, and I have yet to find a consensus of people here who believe they are better off.  Most feel the country is better off, but individual circumstances haven’t improved for many.  As long as Nelson Mandela lives, most South Africans will remain optimistic.

On December 16, the country celebrated the Day of Reconciliation.  Besides being a public holiday, a 10K race was run through Gugulethu, one of the nearby townships we had visited with Boy back in October.  I ran this with one of the other dermatology registrar, Ranks, who is from Lesotho and just getting his running career started.  In addition to the crowd of runners, the people of Gugulethu came out to cheer and jeer the runners on.  I had been told to bring a bag of candy (“sweeties”) to toss to the children of the township, as this had become something of a tradition for this race.

Early in the race, a Black South African runner asked after I had given a sweetie to a little girl, “Do you feel reconciled now?”  I sort of laughed and tossed off the comment, but spent the rest of the run thinking about the shouldhavesaids, like “This isn’t my country, I’m just here for the exercise!” or “I have nothing to reconcile, this is your (South Africa’s) issue to tackle.  I’m here to try to help in a small way.”  In the end, it’s probably best I kept the shouldhavesaids to myself.  As Gulam once said, “Doctor Roy, you’re a strange man in a strange land.”  How could I possibly understand reconciliation at this level, in this country, with this history?  Stick to what you know, Strange Man, don’t presume to know better or have the solutions.