Monday, March 31, 2014

2nd weekend: relaxing on the coast

first of all, if you read nothing else in this post: the eastern coast of south africa is an underrated, perfect vacation spot and you should all go there. probably tomorrow. 

this week's trip: orientation
after only a short drive of 1.5-2 hours, MB and i arrived friday afternoon to the bewilderingly lovely colonial masterpiece that is fairmont's zimbali lodge.

drive up to the reception
our room overlooked the vast coastal forest which blankets the land down to the indian ocean. the ecosystem here was quite different from the savannah/bush where we're staying at the lodge. we were instantly warned about the vervet monkeys who lived on the property: much smaller and gentler than their baboon cousins, however wickedly smart and able to get into the rooms (for snacks!) if you left the balcony door unlocked. i saw one briefly and mistook it for a cat; probably for the best or i might have attempted to play with it!

view from the balcony of our room
the property was quite vast and different buildings were somewhat isolated from each other requiring golf-cart drives between them; our driver the first night described the previous night's drive when he was stopped short secondary to a large python (of which he could see neither the head nor the tail as both were in the woods) completely stretched across the road. in case this wasn't enough, there was a full page in the welcome book in the hotel room dedicated to "what to do if you get a snake bite" which humorously began with "please phone the reception" followed by "remain as calm as possible." spoiler: we didn't see any snakes! 

what we did see: beautiful, beautiful things! we spent most of the weekend napping at the pool, reading, admiring wildlife, and even dipping our feet in the indian ocean. as many of you reading this in NY can attest to, the pool and/or beach and a temperature allowing for entering said bodies of water without developing frostbite is a sight for sore eyes this winter. all hail the southern hemisphere! genius! 

the site of most of this weekend's action

even in the peacefulness of it all, i felt like i learned a lot about this part of south africa and its wildlife. i'm a bit of an amateur photographer (all credit to my husband, Henry, who i miss dearly back in NY), and what you'll find that follows are my attempts at documenting some of the beautiful parts of nature we experienced this weekend. cheers, you guys! here's to another great week at edendale... and more adventures along the way!

until next time,

one of the many, many lizards we met. 
macro shot: beetle, ants, blooming flower. 
another macro shot: spiny caterpillar
the indian ocean: no swimming! (see: strong tide and sharks)

sea dune greenery

one more macro: seaweed washed up on the coarse sand.
the universality of sea and sand. can't beat it.

allocation of resources & teaching

it's been a few days' hiatus from the blog, however i assure you much has transpired despite the availability of the world wide web! for ease of reading (and writing), i'll tell you about a few days at a time here and in my next post.

last thursday was our first taste of rain and cool weather. this made navigating the outdoor wards a bit tricker, although a whole lot less sweaty for all parties involved. (hooray!) prior to catching up with the registrars for rounds, we accompanied dr. draper to the radiology department to make a case for a patient having a CT chest. 

visiting the radiology department
it was a pretty straight-forward request, really. 60-something year-old gentleman, long-term smoker, recurrent right-sided pleural effusion requiring chest tube drainage with suspicious-looking CXR. six weeks prior, when a CT chest had been requested, radiology had denied the request stating that because cytology had been sent from the pleural fluid sample, the results would need to come back prior to obtaining the CT chest. [at edendale, if you want an imaging study, you must fill out a "request form" for the radiologist and plead your case. the radiologist has the final say in who gets imaged. tests are not guaranteed to be done.] after six long weeks, the cytology came back: negative. nobody really believed it; certainly his story, imaging, and clinical signs were still quite suspicious. cytology is notoriously low yield anyways, and it was a head-scratching decision to have waited for its results until the CT was obtained. 

armed with this information, we followed dr. draper into the head of radiology's office. he pleaded his case on behalf of the patient. "his diagnosis has already been delayed six weeks," draper reasoned. the radiologist faltered: "can't you send off some kind of tumor markers or something?" the discussion continued; after almost begging hand-and-knee, the radiologist relented and gave the patient a CT chest spot THREE weeks in the future.
although we occasionally have our issues getting imaging done at columbia, this was certainly shocking. a timely article in the health section of this week's mail & guardian (south african newspaper) addresses the frustration of regular south africans who need outpatient imaging tests, and unless they have oodles of cash lying around, have to wait two months to obtain them (and still pay a fee!). i'm still learning about the south african healthcare system, but it seems to be similar to many others throughout the world where there's a huge chasm between public and private; those that don't and do have money.

the interminable wait for imaging
afterwards, we headed out to the con wards (outdoor wards i previously described) for rounds.

the walkway to the outdoor wards
i've really enjoyed rounding with dr. draper. he has a strong clinical sense and excellent bedside manner; he looks at patients as a whole and then focuses on specific points of their care to teach the team. interacting with the staff throughout the open wards, you get a sense that he holds respect from them as well. he speaks a bit of zulu and is religious about organizing the paper charts (carries a small stapler and portable hole-punch with him!). he is an excellent role model for the registrars here and undoubtedly has a strong impact on the tone of care on the wards.

a medical ward: windows open, breezes crossing through, nurses hard at work
the variety of diagnoses i'm exposed to on a daily basis is staggering. i find myself often asking, with eyes wide, "does that present that way? how often do you see that? wow, i had no idea..." i feel very lucky to have this opportunity; even if i never see these diseases or presentations going forward in my career in the US, the experience of growing my clinical experience and ability to think "outside-the-box" of typical cases is invaluable.

 oxygen at a patient's bedside. open wards don't lend well themselves to wall oxygen points.
an aside: for those asking about whether or not marybeth's black cloud stowed away on the plane to africa... i think she might have left it at milstein. (can anyone confirm or deny?) i can proudly say that we haven't had any patient care disasters occur that are exceedingly different from the usual here. so... WHATEVER YOU ARE PRAYING, KEEP PRAYING. :)


after the rain and cool temperatures of thursday, we woke up to absolutely gorgeous skies on our drive to work friday morning. although i am not a morning person (not even a little bit), it's been a lovely experience driving to work at sunrise. on the left side of the road. with cows and pedestrians and things. but seriously!

clouds, mountains, and cars coming up at you on the wrong side!
on friday, we had prepared teaching for the department's current hoard of clinical medical students! our topic was ECG reading, one specifically requested by the group. MB had rustled up an old powerpoint, and we put some cases together to make things more applicable to the patient population. after morning report (which on this particular day was a very positively-toned M&M conference), we swiped a projector, computer, and screen. MB manned the powerpoint, and i took the whiteboard to jot salient points as we went along. our conclusions? medical students everywhere are the same: totally smart, hilarious, and easily overwhelmed. (plus, who doesn't love the shouts of 'atrial fibrillation!' and 'V TACH!' in a south african accent?) we resolved to meet again next friday for CXR reading.

after teaching, we gathered with the residents for what they call "tea", but was really indian-themed catered lunch in the morning report room (dominican friday, columbia?). this was one of the best opportunities we've had so far to just kick back and chat with the registrars and interns about life in general. we chatted about the differences in our medical education systems, then transitioned to where we should go on safari. and oh, that roti. mmmmm.

roti friday!
we had a low-key afternoon of helping out with technological things (helping to set up video-conferencing... not sure how we got picked for this task, but it worked out on the end!) before we packed ourselves into our little left-sided toyota corolla and headed for the dolphin coast. could really get used to this mini-vacation-every-weekend-thing.

until next time,

Thursday, March 27, 2014

day 7: adventures in N95-mask wearing

after a fairly uneventful (but eye-opening) first day and an (unfortunately) eventful second day, marybeth and i entered edendale on wednesday without a sense of expectation apart from our eagerness to continue to learn and experience new things! today proved to have a theme which will likely permeate through most of our days here: tuberculosis.

what do you know about TB? at columbia, many of us have seen at least a handful of cases of TB in our immigrant population. did you know that according to both CDC and WHO, TB is one of the world's deadliest diseases? they estimate up to 1/3 of the world's population is infected; that last year alone, ~9 million people became infected and 1.3 million died ( the most recent US data: 9,945 cases in 2012 (3.2 cases per 100,000 people); over half of these cases (63%) were in foreign-born people living in the US. in south africa, 1% of the entire population contracted tuberculosis in 2009: 139,468 (949 cases per 100,000 people). additionally, there is >70% co-infection rates with both HIV/TB (HIV being a topic for another day; >30% of south africa's population is infected with HIV, the highest rate on the entire continent). in south africa, specifically kwa-zulu natal province (where we are located), multi-drug resistance (MDR) and extensively drug resistant (XDR) TB have emerged and are huge problems; this has much to do with late detection and incomplete treatments. (

it is within this population that we work each day; although stuffy & claustrophobia-inducing, we don our N95 respirators religiously in the hope that we won't inhale too many tuberculosis bacilli to become infected ourselves. today's morning report case was a fairly common case: a young gentleman with weight loss, cough, and upper lobe findings on his CXR for whom the overnight medicine registrar could have diagnosed tuberculosis in her sleep (and might have!). the reason it was presented at morning report was not to highlight a rare diagnosis (as we do at columbia), but to solidify for interns and registrars the management of sensitive, MDR, and XDR disease. i was absolutely fascinated; for me, this was not solidification of knowledge, but a whole new realm to explore. (i'm sure the budding ID specialist in me helped with the fascination part; some of you might be nodding off now...)

morning report today: pretty routine (for edendale) case of pulmonary TB. if you look closely at the board, the discussion surrounds MDR and XDR TB -- what they are and their risk factors.
as if to highlight the above discussion, we spent the day with several registrars in the triage area of what is usually the medical outpatient department (MOPD) which was closed from the day prior's sewage leak. we encountered at least 5-10 patients with either confirmed or suspected TB. one gentleman seemed to highlight the above discussion too well: a strikingly cachectic zulu-speaking man in his 70s, perched on a wheelchair, a simple face mask placed haphazardly over his face whilst he coughed heartily around it without regard to his neighbors. on review of his chart, he had been diagnosed the prior year, prescribed therapy, and promptly stopped taking it for unclear reasons. he presented to the clinic on this particular day for what he described in as many words as blood-streaked sputum. did he now have MDR TB? maybe (although we joked he may not have even taken enough of the therapy initially to induce this). how many people might he have infected over the past year coughing, coughing, coughing not on therapy? likely many. the registrars admitted him to reinitiate therapy, and we all kept our N95 respirators snug on our faces for the next few minutes... uneasily taking them off sometime later knowing that TB particles can remain in the air up to 6-8h after they're coughed there. 

posters all over the clinical areas act as reminders of the MDR drug regimen adopted in south africa.

although pulmonary TB is a commonplace diagnosis here, extrapulmonary TB is equally as common with varying sites of infection, especially given the high prevalence of co-infection with HIV. already, i've encountered patients with miliary TB, massive pleural effusions requiring chest tube drainage, scrofula (tuberculous cervical lymphadenitis), several cases of TB meningitis, and a fontal lobe tuberculoma. another clinic patient this morning was evaluated for gastrointestinal TB; i'd expect more pott disease (spinal), however the lack of availability of imaging likely limits this diagnosis and it may be more prevalent than can be identified.

looking forward to learning more about tuberculosis this month -- and the multi-faceted approaches to start controlling the epidemic. here's hoping my N95 stays snugly on my face and my fascination doesn't lead to seroconversion!

until next time,

Wednesday, March 26, 2014

day 6: settling in & a few hiccups

thought you all might enjoy a quick exterior tour of new workplace: 

driving in to the hospital. most signs are in both english and zulu.
just after coming through the front gates: new building being constructed (new ED, outpatient clinic)
driving around the back of campus for parking: great view of the main building.
another view of the main building. the trailer in the foreground is the iteach office which is home base for us.

our second day (tuesday) at edendale started in a very familiar way: 8am morning report! led by the post-call registrar (resident) or intern, the flow is fairly similar to any other morning report you might find yourself in: a case presentation followed by discussion. at edendale, the post-call intern or registrar typically presents an interesting case they admitted overnight. it's not typical to have any "admission labs" back at that point, and no imaging would have been available apart from radiograph films which could be viewed on the light box. the focus is primarily on the presentation, physical exam, and differential diagnosis; the discussion typically focuses on the management of the ultimate diagnosis.

morning report room. note the light box for xrays on the front table. no computers here!
at the end of morning report, an actual morning report (fancy that!) is given to the teams coming on to intake (call): number of patients waiting in the ED for beds, to be admitted, and any exciting overnight events. on this particular morning, the night resident also interjected that part of first floor of the hospital was completely uninhabitable secondary to sewage pipes having burst in the hospital overnight. (suffice it to say, we weren't the slightest bit disappointed to wear our masks today!) this rendered a large part of the ED, the waiting area, and a room where already admitted patients waited for beds (columbia people: think 'launchpad' patients all put in the same room!) completely unsafe for people. additionally, the operating rooms had to be closed. the medical outpatient area (MOPD), which had actually been without lighting for unclear reasons the prior day (clinics were being held in semi-darkness with flashlights!) would also have to be closed. so much for business as usual to get oriented to.
the ED: i had snapped this picutre the day prior to all the excitement.
as a result, the consultants (attendings) and medicine teams sprung into action and all descended on the inhabitable parts of the ED and waiting area. it was amazing to watch the surgeons, ER docs, and nurses all pitch in to help find places for patients to wait to be evaluated -- and to watch all the medicine teams work tirelessly to help triage patients as quickly as possible to ensure expeditious care for the sick. ward rounds had to wait. although it was far from a "normal" day at edendale, i quickly got a sense of the spirit of the place and the admirable efforts of the teams.
this appeared in the doctor's room sometime in early afternoon. (MOPD = outpatient clinic area)
getting better acquainted with members of the team and nursing staff has helped flesh out edendale hospital's motto: silwanezifo, silwanobubha, sinikaithemba (zulu for 'fighting disease, fighting poverty, giving hope'). it is a place of tremendous hope in a country struggling not only with the devastating disease burdens of HIV and tuberculosis, but the after-effects of years of apartheid -- a place where passionate, deeply-caring white doctors work alongside their zulu brothers and sisters, striving to mend broken relationships, all aiming for a common goal of bettering their community and ultimately their country. i consider it a tremendous privilege to be witness to this, even in small ways available to me... even on days the hospital is covered in sewage. :)

until next time,

Tuesday, March 25, 2014

day 5: welcome to edendale!

yesterday was our long-awaited first day at edendale hospital. 

waking up quite early, we left for the hospital before the clearing of the daily heavy mist-like fog which blankets the hilltop on which our lodge is situated. visibility was low, but surprise! in the short distance from our lodge to the front gate of the reserve, the thick, curled horns of african buffalo popped into view from the mist. they quickly scattered. our eyes now keen for animal-spotting in the mist, we identified several small monkeys in the nearby trees. i'm sure at some point this stuff gets old for south africans, but for us -- a constant thrill!

we arrived at the sprawling hospital complex shortly after 7am. lost immediately, we eventually made our way to the iteach office. we were greeted warmly and led to the main hospital building by sipho (who had met us at the airport) where we climbed the five flights of stairs up to the medicine department on the fifth floor (avoiding the elevators secondary to increased risk of tuberculosis transmission, although we had our masks on at this point. columbia colleagues -- our explanation of the 168th street 'tuberculator' rendered a hearty chuckle from sipho!) 

after spending a few minutes in morning report, we met dr. wilson, the soft-spoken & incredibly gentle head of the medicine department. he gave us a brief introduction to the hospital, followed by a quick tour of the hospital. he showed us the labs, several wards, and eventually landed in the ED. we saw and examined the patient who had been presented at morning report -- at that point the differential was a viral hemorrhagic fever vs. rickettsial disease (e.g. african tick bite fever). (ID GEEKS UNITE!) fortunately, the latter was diagnosed and the patient was able to go home with a short course of antibiotics. 

we spent the rest of the day rounding with drs. wilson and draper and their respective teams of registrars (residents), interns, and medical students. the hospital has a section of large open wards in one-story buildings connected by a network of pathways covered by sheet metal. each ward is roughly the same design: a large room with many numbered cots. a bedside table holds chart, xray films, pitchers of water; each building lined with large windows filling the space with light and louvered blinds allowing the breezes to blow through (although this is my assumed purpose for the open windows, i later learned they are primarily for airflow to decrease the transmission of TB). a few nurses dressed in freshly-pressed whites sit at tables near the front. the wards range in acuity: the two we rounded in were roughly equivalent to a regular medicine ward and then a more "stepdown" type ward (more oxygen points, lower nurse:patient ratios, greater care needs). 

a few observations from the day:

although we value our privacy in the US, there were some benefits to the open-type ward that i quickly appreciated. first off, rounds were completed at the bedside for every patient and exceedingly quicker -- you walked four steps to the next patient rather than to a room on another floor. because everyone could see the doctors rounding, there also existed a heightened respect of the doctors' work and a patience on the part of the patients until it was their turn. additionally, patients could be grossly observed at all times for any clinical changes and any needs -- no need for call buttons or waiting in an isolated room unattended to. obviously, there was a tremendous lack of individual privacy and heightened risks of infection transmission. even so, this type of ward seems to work efficiently here.

the variety of illnesses treated is somewhat different from the US, as is the approach to taking care of hospitalized patients. here, there seems to be a much greater emphasis on diagnosing and treating the acute illness. one of the reasons for this, quite simply, is that apart from HIV/AIDS and TB, patients here carry many fewer diagnoses of chronic illnesses. in the US, many of the "diagnoses" that we attach to patients are directly related to incidental findings picked up on labs or imaging. the allocation and availability of such tests are totally different here in south africa; for example, on rounds, an intern reported that an inpatient had an MRI scheduled in 7 days and nerve conduction studies scheduled in 14 days. these times are reflective of the standard time for such tests to happen and significantly limit the use of said tests in coming to diagnoses. although this does limit care in some important ways, it results in patient presentations lacking an extensive list of potentially misleading prior diagnoses that might cloud the judgment of the evaluating practitioner. i am not suggesting fault in our western system -- only highlighting what i see to be some of the benefits in a very resource-poor system. ultimately, i believe there's a balance here that lies somewhere between our two systems: using the appropriate tests and resources (not more or less) will likely lead to the highest quality efficient care. 

clearly these observations are my own and quite early in the experience; i'm sure my ideas and impressions with morph and grow throughout my time here. 

we made our way back to the lodge in the later afternoon after a really excellent first day. and... we finally met the property keeper, rob. we'd heard a lot about rob from others. he's quite a legend. and he lives up to all of it. rob pulled up in front of the lodge to greet us having had a long day building a pen of sorts for some of the buffalo. plying him with an icy cold coke from our fridge, we mentioned we'd love to see some animals... at which point, he offered to take us on an impromptu game drive around the property! we both hopped in the passenger seat in the front cab of the truck and we were off! according to rob, most of the animals are out at twilight -- and he was right. see pictures below for some of our new friends: we came across zebras, 'goliath' the large male giraffe, buffalo, a million and a half warthogs (including one of his pets, 'chop chop', although his other pet 'pumba' was nowhere to be found), two lovely white rhinos, some impala and other small deer, several eagle owls... and a long wait at a difficult-to-get-to watering hole for two hippos (who never emerged, although by that point it was almost pitch black out). ...and twenty minutes later we were back at our lodge. throughout the ride, rob told stories. fabulous stories. he's a bit of an animal whisperer by his own accounts and we're fully inclined to believe it.

looking forward to more adventures at the hospital and around the bush.

until next time, 

'chop-chop', one of rob's semi-domesticated pet warthogs!
zebras: much better camouflaged in their surroundings than i expected.
'goliath' really likes having his picture taken according to rob
yes, mom, we were that close! two female white rhinos.
sunset on the reserve. we love you, south africa!

Monday, March 24, 2014

day 4: royal natal national park

on sunday, our second day in the drakensburg, we woke up to perfect sunshine. our plan was for hiking, although neither of us is much of an accomplished hiker. we drove to the visitors' center in royal natal national park just a few kilometers from our hotel. there, we decided on which trail to do (spoiler alert: we picked "easy"! double spoiler alert: "easy" was not easy). we spent the better part of three hours proving we weren't athletes. 

such exotic trees along our hike. MB demonstrating the endless uphill trail!

about halfway through the hike, we crossed a road and entered a separate trail that led to the bushman's paintings, ancient sandstone rock art. although we had previously been on our own, it was under these circumstances we met our guide, elijah.

the view behind us from the trail leading to the bushman paintings. difficult to focus on hiking with this view!

how can i begin to describe elijah? born and raised in the zulu community just north of the tugela river. he exudes a passion for his heritage, but also for his ongoing legacy. before we reached the summit of our climb, marybeth and i had already been taught (and rehearsed) the three types of clicks found in the zulu language, identified and admired several types of south african trees, and learned the colorful history of his tribe. elijah described how the park was one of the few left in the nation where local people served as guides on the trails -- and how important this was for attempting to salvage the years of unwritten history of his people through teaching hikers like us one by one. 

elijah, the constant teacher

elijah also spoke of the utmost importance of education in his own life while relaying his concerns about what he saw to be the abysmal state of education in south africa. we spoke specifically about the monumental problem of HIV/AIDS; how previous organized attempts at educating his people, the zulu people, about wearing condoms to prevent transmission had back-fired into gestures of cultural solidarity in NOT using them. he described how the government subsidies to new mothers/babies had also back-fired in a largely uneducated and intensely impoverished population: girls were misguided and encouraged to become young mothers in order to obtain these grants.

although our conversation topics were heavy, we reveled in elijah's candid nature, his unique gift for the spoken word, and the passion with which he seemed to live the entirety of his life. he described his spiritual life (in fact, he had just come from church to give us this tour), his bachelorhood, and his dedication to growing both his army of tour guides... and his youth soccer team. 

at the summit of our glorious hike, we found the cave paintings! many on lower rocks have been faded over the years (by tourists and otherwise), but the ones on higher rocks were stunningly detailed and fascinating. 

the cave paintings: each is a different species and meticulously colored.

i feel lucky to have chosen the hike to the cave paintings today: lucky to have met such a kindred soul here in such a remote, unspoiled place; lucky to begin to start learning about the state of south african from a south african. he offered a voice for a group of people who often do not have much of one.

our new friend, elijah.

on our drive out of the park, we ran into a few furry critters hanging out in the road. apparently these baboons have been a bit of a menace for campers, but we were instantly drawn in by the mom helping her baby cross the road. another big baboon had planted himself smack-down in the middle of our lane, likely in an attempt to help their crossing. i know i shouldn't play with wild animals... but aren't you just a bit tempted here? don't worry, mom. i stayed in the car. 

road block: baboon style
mom and babe crossing the road

we ended our day with our exceedingly beautiful drive back to pietermaritzburg (identifying the following delightful signage). cheers, for now, friends! missing you all dearly, but -- as i'm sure you can tell -- living quite a colorful life here until we meet again.

cows: next 3 km!
! goats !

Saturday, March 22, 2014

day 3: arriving and first weekend adventure

and we're here!
our journey began early wednesday morning with a long-awaited drive to JFK airport.

me & marybeth, bright-eyed & bushy-tailed boarding our first flight in NY.

after just shy of fifteen hours, we arrived in johannesburg airport on thursday morning! our first impressions? colorful, bright, modern, clean. 

johannesburg airport, mural of subway tiles near baggage claim (makes us feel at home!)

we then hopped our commuter flight to the one-runway adorableness of pietermaritzburg airport! seriously, there is no baggage claim; some guy just carries your bags in from the plane. ours were sitting next to two boxes with live parrots. no, to pre-empt your question, they didn't say anything to me. 

sipho (from the i-teach program of whom we're guests) met us at the airport where he singled-handedly helped us pick up our rental car and allay our left-sided driving anxiety. marybeth was brave enough to go first! she did awesome, jet-lagged and sleep-deprived and all. she hit ZERO pedestrians, a true feat of heroism given pietermaritzburgers' seeming propensity to throw themselves into the street at the sight of a passing car.

marybeth: brave first volunteer in action!
sipho led us to a local grocery store to pick up a few essentials then onward to the lodge after that -- many kilometers outside of town in a picturesque hilltop on the way to albert falls dam. an idyllic setting full of blue and green and sunshine; sounds of crickets and frogs; smells of grass and wood and clean earth. upon entering the reserve, you drive around a hundred yards or so on a paved road, then take a sharp right turn into the grass. the bush, in fact. after another hundred yards or so, you arrive here:

our home for the month: is this place real? 

i could go into the specific details of the home, but suffice it to say the place works well for us and will be a great place for rest and retreat throughout the month. we've already met several species of (medium-sized?) african spiders -- creatures we have resolved to live with given their insatiable appetite for mosquitoes! after a deep and glorious sleep recovering from our day of travel, we woke up and met some of our neighbors: african buffaloes, a pack of warthogs (with babies!), four grazing ostriches, and a pack of some type of gazelle or kudu. hello neighbors, indeed! 

african buffalo ... and the little warthog on the right.
not pictured: the rest of the warthog family who quickly scurried off!

ostriches. these guys are way bigger than i expected. way bigger.

for our first weekend trip (we will have three total weekends here, all off work, all with small trips planned around the province of kwazulu-natal), we took a road trip up to the northern drakensburg mountains. the drive took about 2.5 hours, the last 30 minutes of which we carefully meandered up a narrow, curvy, mountainside road without guardrails, made even more difficult left-sided. even so, making it to our destination was totally worth it: mont-aux-sources hotel at the foot of the 'ampitheatre', an absolutely breathtaking rock formation in the drakensburg mountains. 

a map for reference: we started near pietermaritzburg and drove northwesterly.
the green patchy areas are all part of the drakensburg mountains bordering the nation of lesotho.

the view from lunch on our hotel's patio, ampitheatre in the distance. breath-taking.
we spent the afternoon exploring the mountains -- by horseback! marybeth is an accomplished horseback rider in a former life; i'm a bit of a few-lessons-when-i-was-12 sort of gal. despite the fact that the horse i was plopped onto went rogue and ran me through a few bushes, we had a fabulous time. (marybeth says i shouldn't worry, but given we're both headed into infectious diseases, i'm closely monitoring my arm wounds for any evidence of sporotrichosis.) but truly, it's hard to imagine a better way to view the valley and mountains than prancing through it all on the back of a semi-wild horse. 

helmet-ing and saddle-ing up! safety first, you guys.
mandla (our guide) and marybeth on their not-going-rogue horses. in all fairness, mine settled down about halfway through and resolved to stop trying to throw me off and just nibble grass instead :)
we're settled into our hotel for the evening (first taste of real wireless internet, quite a luxury here) and plan on hiking through the mountains tomorrow morning before heading back to the lodge for a good night's rest. we'll start at the hospital on monday morning and are looking forward to starting the rotation. more to come on our adventures.

not bad scenery in the rear-view mirror, eh?
lalani kahle, all!
(zulu for 'good night')

until next time, sharon