August 25, 2004

We’ve been in South Africa for just more than a week and we’re slowly making adjustments. Through the jet lag and culture shock, we’re starting to get oriented to the left side of the road, the safe side of town, and the reversed direction of flushed toilets.

We’re currently staying in a cottage along the road between Constantia and Hout Bay, called Constantia Nek. The mountains here are incredibly dramatic, and are visible everywhere. They are rugged and rocky, and despite their stasis, they never look the same, since the light here gives them a very dynamic quality. We’ve arrived in mid-August, wintertime here, but very spring-like from what we’re used to. The mornings and evenings are nippy, but most of the day is a pleasant 60-something degrees.

To fly to South Africa requires approximately 24 hours from Seattle. We stopped off in Boston to celebrate my grandmother’s 100th birthday for 4 days before heading on the rest of the journey. From Boston, we took an all-nighter to Amsterdam (6 hours’ flight), then after 3 hours, headed non-stop to Cape Town, 12 hours, most of it over the African continent. Africa is geographically under-scaled on most globes and world maps. It is a huge land mass. Approximately 3 hours were spent over the Sahara desert. We then nipped the west coast near Cameroon and Nigeria, then finally to South Africa, landing in Cape Town well after dark. Two hours before landing we saw what looked like burning fires, either forest fires or from villages.

Landing in Cape Town at night doesn't do it justice.  The night was chilly, and the air smelled like wood smoke. Most of the airport workers wore jackets and sweaters and knit stocking caps. The airport is adjacent to the Cape Flats, a large area where thousands of Black Africans live in shanty towns. Their housing is made from scraps of wood and corrugated tin and tends to house way too many people. Needless to say, disease, hunger and crime is the norm there.

We were met by a “micro” bus driver, who managed to stuff us and our stuff into the van and head to our accommodation. We unloaded and fell into a deep, jet-lagged sleep, waking up late the next morning to cheeping guinea hens, odd-looking semi-flightless fowl with black and white speckled plumage and a weird cashew-shaped horn atop their heads. These and the Egyptian geese have become our temporary default pets.

Our first real day in CT was spent picking up a rental car and then driving, with manual transmission under the influence of jet lag down the left hand side of the road. The hardest part was trying to operate the “clicker” (turn signal; located on the wrong side of the steering column) while shifting down while turning right at a traffic circle. Once I was able to do this without getting clipped from the right and without tearing off a side view mirror and without having stress incontinence, I knew I could make it here.

After getting the car, we went immediately to Table Mountain and took the easy way up: a dizzying cablecar ride to the 3000+ foot plateau of this amazing land form that distinguishes Cape Town as one of the most picturesque cities in the world. The view, though giving us a gross orientation to the city, the two oceans, and the continent, also gave us terrific vertigo.

August 30, 2004

Today we bought a car, not a small task in a city where all cars are overpriced by US standards and one doesn’t really know what one is getting. You can't really get by in Cape Town without a car, and for a family, you need two.

Today we also signed a lease on a house for the year. The house, also known as “Owl Glade” had been a guest house under a previous owner, is located in Constantia, the same ‘burb where the kids’ school is. This area is known for its vineyards . As opposed to the automotive market, the housing market at this time of year favors the renter, with a number of available places that haven’t been rented for up to a few months. Unfortunately, there are fewer places that are furnished, something we were looking for as we brought nothing but the bags we checked on the flight. So our our will come empty.

Being located at the top of a hill, the security of this house is not as big an issue as a place located on a flat property. We’ve been hearing since well before we left the US that South Africa has crime problems, driven in a large part by a huge socioeconomic disparity. Securing one’s property and personal safety has been a tricky line to walk. On the one hand, we want to be smart and know where not to go when, but on the other hand, we don’t want to lock ourselves in a compound surrounded by electrified wire, a high wall, a guard at a gate and electric beams inside the house and in the yard. I think this latter scenario is one that many newcomers to the area get themselves into. We looked at such a security estate today that resembled in many ways a penitentiary located just up the road. Even within the walls and fences of the “compound”, many individual houses were within another wall or fence, and I’m sure all of the houses had alarm systems. Without experience with reality here, we’re trying to be intelligently cautious. Our place seems to be safe without the additional security accoutrements.

The kids are in the American International School of Cape Town and have adjusted amazingly quickly. Clara had a friend invite her over after her second day of school and Jimmy had a sleep over after one week. The mix of nationalities and races makes the school legitimately international, rather than a white bread euphemism. The school seems a good fit, and we selected it mainly based on the school calendar, which runs from January to December for every other school except this one. Jimmy is playing in the steel drum band.  Jimmy’s main friends are Sipho and Tyler (Ty). Sipho (pronounced “Seepo”) is a Black South African who is a great kid. His family lives in Hout Bay, adjacent to a settlement of Xhosa and Zulu-speaking Africans. Whites in the area call it a “squatter’s camp”, others call it an “informal settlement”. Hout Bay definitely feels more African, despite the fact it is flanked by Constantia on one side and Llandudno and Camp’s Bay on the other. Hout Bay calls itself the “Republic of Hout Bay”, highlighting an independent leaning in the place.

This city really has a fitness culture (again, primarily available for those with time and money; in fact the Black Africans and Cape Colored (an acceptable ethnic term here) who do much of the labor here are probably in very good cardiovascular shape given that they walk a lot and are doing more physical work). Cyclists dressed in the brightest Lycra on their expensive road cycles are on the narrow roads in big numbers. Many people jog/run (though few Blacks; conversely, you infrequently see Whites walking along the roads). The Table Mountain trails are filled with people of all ages on the weekends. Mountain biking, surfing, kite boarding are all popular here. Spectator sports are also very big, too, though we haven’t taken in any of these: rugby, cricket, football (soccer) are the big ones.

September 27, 2004

We’ve been here now for close to 6 weeks. Life is settling to something of a day-to-day and week-to-week routine. I seem to be spending an inordinate amount of time meeting with and communicating with people regarding telemedicine. Despite all of this schmoozing, the project (see "Teledermatology" link) is sputtering along. Human subjects has finally been approved from the UW end. I believe we have identified 3 sites for telemedicine: one in Limpopo province, way in the north near Mozambique, one in the Transkei, Eastern Cape, and the other came ready-made, hopefully, in a town called George, in an area called the Garden Route. This is the southern portion of the Western Cape, and is supposed to be beautiful there. The kids have a week off from school, so I may make a pre-site visit to have a look around.

I cannot legally touch, let alone treat, patients in the clinic or hospital yet. I spend a lot of my time looking over the shoulder of the registrars, which is useful to a point, but grows tiresome, especially for them, I fear. I also don’t want to make the trainees paranoid that I am observing them. Some of them are my age or older, and are generally very bright. I would be very inadequate in the clinic just yet. The system feels very foreign despite almost everyone speaking English. For many patients, this may not be their preferred language. Almost everyone also speaks Afrikaans, a Dutch/German-based language equivalent to South Africa Creole. I don’t understand a word of it. Then there are many African people who speak Xhosa (pronounced with a sort of hard clicking “cl” sound that is remniscent of “The Gods Must be Crazy”).

Africa’s relative slowness is becoming my reality. High speed Internet is available, but it will take another 3 weeks to get here (is that really high speed?). To find a shovel to use around the house took almost 2 hours and the tool looks like something you would take camping to dig a latrine. Don’t go grocery shopping on a Saturday morning, ever. Capetonians seem to try to make up for the slowness by driving faster. Ah, two can play at that game. I’m getting good at the driving thing.

September 30, 2004

Still not Internet connected, thanks to Telkom's monopoly on telecommunications.  The telemedicine project is in part based on the assertion that South Africa is a well-connected country electronically. Internet penetration has run far ahead of health care, so why not use this electronic capability to better enable health care? The gap between electronic capability and reality, though, remains to be seen. I lost sleep last night thinking about the many steps that could get screwed up in a seemingly simple process of taking digital images, uploading them to a PC, attaching the images to email and then sending them to me. This assumes a lot of things that in most "1st World" nations are part of everyday life. When I recently lectured to a group of nurses taking a course in dermatology at UCT, after which they would then become their communities’ specialist in skin diseases, only 2 of 9 had ever used email. The glimmer of hope that I had was that one who had an email address, used it and happened to live in one of the more remote areas (Limpopo) that we are targeting as a telederm site. We’ll see…

The main competition to Telkom is cell phones, and many choose not to have a land line connection at all. Cell phone use here is incredible, with 40% of the population using one. Usage is not cheap, either, as we are finding out with our “pay as you go” plan. Several things are set up this way. Electricity, for example, is purchased in advance at a shop and then this purchased power leaks away until the amount is used up. Though I’m probably paying much less for power here, I sure am more compulsive about switching off lights and heaters. This is a good thing. I’m also stingy about my cell phone use for the same reason.