Winelands marathon: No wine but ended up legless.

Last weekend I ran the Winelands marathon in Stellenbosch. It was my first ever marathon and what an experience!

If a visitor had happened to be arriving in Stellenbosch - for some unknown reason - at the ungodly hour of 5:00 am, they could have easily thought all was normal in this quiet town, home to the Cape’s best wines and white colonial buildings. However, if they had come across the road beside the running track they would have been a little shocked find it packed with 600 plus people in tiny shorts, jogging on the spot to keep warm, and dance tunes blaring out over a PA system. I was nestled in the centre of the crowd. There was tangible excitement - and nervousness!

And we were off! The race weaved its way out of town and climbed a gentle hill through the vineyards. A gentle mist still lay between the vines as the dawn sun strained though the clouds above the mountain behind us. A beautiful start to the race.

Quickly the runners spread out and for most of the race I was running alone, with a few people always in view ahead and behind.

I had been advised to take it steady to begin with. So the first half of the race felt like waiting for the time and km to pass, before the inevitable hard work to come.

As expected, the second half was a real battle to keep the pace going. I got myself through twenty minutes of it by refusing to let a runner behind me to overtake me, putting in little spurts every-time he tried to pass. When he finally overtook motivation took a real low, made worse as the course became constantly undulating!

At this point I had to have a good chat with myself! First my "inner voice"got angry with me, later I just tried relaxing and not thinking at all, both seemed to work.

When the number of km to go stopped being in double figures, excitement at the prospect of completing grew more and more. My legs felt weird though, it was like rolling my hips over two wooden planks. As I approached the finished, there were more energetic people cheering us on at the water stands, and it was strangely motivating overtaking runners on the half marathon (these people were mostly overweight and them walking not running). I also resorted to the tactic of cheering myself on! With 1 km I got v excited and managed a sprint finish.

I did it in 3 hours 8 minutes. It put me in 44th.

I was exhilarated when I realized I had finished, my legs though felt like they were going to snap out of their joints.

The week running up to the marathon was characterized by overeating. The day before was extreme, worried mainly that my metabolism was just burn though any food in the first half hour, the day before I ate: 2 large bowls of muesli, 6 cearl bars, 8 white bread sandwiches, 3 plates of nibbles at a TB public meeting at lunch time, 2 chocolate muffins, then 800 grams of pasta, and another (small) bowl of muesli at 4:00am. I was seriously close to overdoing it. I hardly slept the night before, in a constant sweat, and feeling like I was going to be sick at any moment. When I was standing on the start line there was a definite hard, heavy, lump at my stomach. Possibly i over did it!

Getting through the marathon was in part due to my Norwegian vitamin friends. As nutritionists they have had great advice! They didn't have any part in the overeating - that was purely my fear of hunger driving me - but gave much much appreciated motivation!

It was a wonderful experience and I think I am quite up for another one at some point!

Global March for TB

“VIVA new TB treatment VIVA” screamed a TB nurse perching on the back of a lorry above a 3000 plus crowd, who chanted back: “VIVA!”. She was followed by equally energetic speeches about the need for new, effective and simple TB diagnostics; new funding into TB research; more HIV treatment; community based care; and even vision and leadership on TB. Music boomed out from the enormous speaker system, on the other half of the lorry come stage, and the sea of red campaigning t-shirts below jived and sung!

The Global March for TB treatment was just warming up. The Treatment Action Campaign (TAC) - most famous for taking Phizer and the South African government to court in 2002 to secure treatment for mother to child transmission of HIV - had impressively bussed 1000s of their campaigners from around South and Southern Africa, to coincide with the international TB conference starting in Cape Town the next day.

I climbed a tree to get a better view. Still dressed in hospital gear: shinny black shoes and blue non-iron shirt, I must have looked ridiculously out of place!

The march set off from the outskirts of town, below table mountain, towards the international conference centre. I joined Rachel (she has just arrived in Cape Town to work with TAC, for those who don’t know her, a great friend since I met her while doing International Health) and flapped a banner asking for improved TB treatment around.

The march went along the main highways of Cape Town and eventually arrived at the conference centre where more powerful speeches were given, including speakers from Latin America and Malawi, and a memorandum was delivered to the head of the conference organizers.

The march marked a new move for the TAC into TB advocacy, who have historically focused solely on HIV. Most HIV patients die from TB, so its a much needed move. And something to get excited about: lack of political action is a big driver of the TB epidemic, and TAC have an impressive track record of getting HIV up the political agenda. Hopefully they can do the same with TB!

It's also politicized my research - TAC are calling for more community based care - its just how the we describe the intervention I'm helping to evaluate.

A new direction

At last a break though! I was trundling along trying to move beyond the planning stage, when I met a lady who is researching a similar topic area as me. We talked about us working together and, following a few weeks of waiting, last week she finally agreed that I could work with her. So I'm off in a new research direction.

You remember I talked about the model of adherence support for HIV treatment was very different to TB? Well, this lady, Salla Munro has implemented the HIV model with TB patients. My original plan was to compare patient experience of HIV and TB treatment support, to ask theoretically what use the HIV model would be for TB. Now I’ll be helping to evaluate how the new model was worked with TB treatment- in practice.

I’m excited because it means I have someone to work with and can hopefully learn lots about qualitative research along the way. It also means I have jumped past the hurdles of gaining ethics approval and securing permission from clinics to do research - usually both arduous tasks.

My responsibility is to organise focus groups with patients to find out how they have experienced taking TB treatment, and then analyse the data with Salla. There are 5 clinics in various parts of Cape with the new intervention. Plus we'll be looking at two clinics with, the classic, direct observation. The work is expected to take until March.

So this week I’ve been getting an introduction to the clinics. They are all in Cape Town's townships. Busy places, much informal housing, and home to millions of Cape Town's poor. On Wednesday I visited 3 of the clinics and in the process got: a new name (Loorwarzi - Xhosa for knowledge), 3 marriage proposals (I think it was a joke, I said no in any case) and met, no exaggeration, 60 new people (treatment supporters, clinic staff etc). The next two days I’ve been heading back to the townships to explore the possibilities for a venue for the focus groups.

Overall though, its great to be out of the office and getting stuck into something new.