Is it a rabbit?

Apparently there is a rabbit in the moon here! We dashed up Lion's Head after medical school yesterday evening to have a look. Unfortunately it was too cloudy to see the full moon properly, but it was a great sunset. I will have to try again next full moon!

Rugby world cup in South Africa

I’ve been lying for weeks. I’ve been telling people here I am a rugby fan. But given the way rugby has creeped not just into every conversation but ever part of life, I think any other option would have been cultural suicide. You can’t tell a proud South African you don’t care either way, including the non-sporty lady from across the corridor when she comes into work dressed in green and yellow.

As the only English person in the hospital, however, has meant I have endured being the butt of all jokes. Its been endless, ever since England took a thrashing the first time round....and its still ongoing.

The build up to game here was mad. On Saturday afternoon I was on way to the beach for some surfing and ever few minutes a car or pick-up would zoom past, windows down, springbok flags out, hooting and cheering like mad. South Africans thought they had already won.

I spent the game its self in a pub just by campus. 50 or more South Africans, 15 or so elective students, who by this stage been caught up in the excitement and gone back on promises to support England, and me. It was lonely. And possibly dangerous - I kept my accent down. I was still though contented that I didn’t really care about rugby, however on kick off I suddenly started to really care! What’s that about!

I spent part of the game chatting to one of the good looking (self proclaimed too) Norwegian students. Having never seen the game before she was shocked at the violence, “do you have kill someone to get a red card?” but also confused, “why don’t they punch each other?”.

Hope its wasn’t too depressing in England after the game. Needless the celebration afterwards here was crazy, people running in the street and springboks shots flying everywhere (green Aftershock stuff with Amarula).

Sunday I escaped for a run. I went from Cape Town along the costal road on the west side of the cape peninsula to Hout Bay. I was meant to be running for one hours and turning round, but on getting over the pass before Hout Bay I saw the beech in the distance and felt I I had get to it. It was beautiful. However on getting back I recalculated in the extra distance I had run and it appeared I had unintentionally ran a marathon. Puts me in good stead for two weekends time I hope!

The running, though, didn’t allow me to escape the rugby. I tried to buy a drink on the run back only to be told I could have it for free as a commiseration prize. After the run I went to buy a burger (I know, but I was hungry). Passion for rugby in South Africa is followed by an almost equal passion for meat, but I never suspected when trying to buy the burger I would be confronted with the choice of a green role for my burger, it glowed fresh from the its radioactive dip.

So its been a hectic time dodging national pride and “What do you do to an Englishman who has just lost...” jokes. Luckily, they haven’t noticed the England vs Russia football results....yet!

Escaping the city

Last weekend (I am really behind on updates) I went to the Cederberg mountains. Its a cross between the surface of the moon and an English country garden and it's achingly beautiful.

Saturday we climbed one of the mountains to an impressive rock arch. It was a real adventure, crawling though rock crevasses a person wide, climbing under fallen boulders and chasing baboons. I went with a group from the elective house at the hospital.

Sunday I couldn't sleep (damm birds - i wasn't feeling nature) so I did a run. Clocked in 28km and spent the rest of the day absolutely exhausted.

The one best things about the weekend was a man called Gheret who ran the lodge we stayed at. He's lived in the mountains for 35 years and has perfected relaxing and thinking. Had some great long conversations with him about all things South African. On the morning before the hike he made these incredible hand drawn maps for us, just like treasure maps without treasure!

An ordinary weekend?

This weekend, I met one of the most powerful people in the world! Angela Merkel the German chancellor visited my hospital as part of her African tour.

It was mayhem, with reporters, and cameramen jostling to get her photo and avoid being trampled on by her 20 plus entourage as she swept into the hospital.

She was here to visit the "Hope" centre, a German-NGO funded project that does community HIV things. An elective student working at Hope had tipped us all off that she might be coming a few hours before. And so a cold, quiet Saturday afternoon suddenly became very exciting. We put on our white coats and they seemed to blag us through all security measures, and even us get us sitting a few rows to the side of Angela in "Hope's" power point presentation.

I didn't understand anything she said but she seemed very clever and energetic. Unfortunately, I wasn't able to ask she was going to meet the 12 billion dollar gap in the Global Fund for AIDS TB and Malaria (though to be fair she did give 10 billion dollars to the fund with Brown last week). The German elective students were very happy to meet her (see picture!). One got interviewed by national radio.

We also met Oliver Beirkoff (scored against England to win Germany Euro 1996 - I had to ask i know nothing about football) and the German finance secretary. I also met the SABC's (South African Broadcasting Corporation) presidential reporter. He has interviewed Thabo Mbeki countless times, so had fascinating chat about AIDS denilism and the Zimbabwe issue. To follow on from the earlier blog post about Mkeki he may be more misunderstood than we give him credit for. The reporter thought Mbeki felt he had been unfairly misinterpreted when he highlighted the links between AIDS and poverty years ago and no longer spoke about AIDS because he was reluctant to be misinterpreted again.

Marathon running

Last week the inspiring Ethiopian runner Halie Gebrselassie broke the marathon world record. A good as week as any to enter a marathon of my own.


I've, possibly naively, entered the Winelands marathon (no drinking during, only after). It's on November the 10th so with only a few weeks training to get under my belt before, the chances of beating Halie's staggering time of 2hrs, 4 min, 55 seconds are slim!

The picture above is a view from the top of the hill I've been running up nearly everyday. My hospital, Tygerberg is one of the tall buildings just right of centre.

What am I doing?

I was on skype to my friend Tom the other day and he asked, "what are you actually doing out there?" I realized I haven't actually said yet...

At the moment I am trying to research how patients can be helped to take their TB medications. Its a big issue: TB is the third biggest killer, and despite decades of attempts to control it the number of people with it are rising. In some parts of South Africa only half of patients finish their treatment. While patients in the West don’t do much better on most treatment, the consequences of non adherence to TB are serious: illness, death, transmission to others and the build up of “super bug” TB that’s resistant to all medication.

TB treatment is hard to take. Its a 6 month course, has horrible side effects and its heavily stigmatized in society. However, the treatment for AIDS is similar, but,the rates of the adherence are higher. Why?

Big part of it might be the way health programs help patients take their meds. TB has relied on direct observation, getting someone, usually a nurse to watch you pop your pills, in theory, every day. But big trials have shown this doesn't work, in developed or developing countries. AIDS treatment has relied on education, lots of counseling about what being in treatment will involve, treatment supporters, support groups and community campaigns. In fact there have been some impressive and inspiring projects that have used this approach to get really high rates of adherence. MSF have run one of the most famous projects in one of poorest the townships here in Cape Town, Khayelitsha.

So this is where the research comes in. I’m hoping to ask patients how they experience HIV and TB services to see what lessons can be found to improve TB adherence in the future.

Currently I’m at planning stage, but its been an interesting journey so far!