Tata Madiba. Father of a Nation.

What could I honestly say that hasn't already been said about Nelson Mandela. And what question about his life could I answer that hasn't yet already been answered by the experts. He was born a poor village boy, fought the unjust Apartheid system in his 20's as a well spoken student of law, served 27 years of political imprisonment, and changed the face of a nation and the world.

To the people of South Africa, he was more than a poster child for freedom, more than a mouth piece, more than a man. He was considered the Father of the new South Africa. I can honestly say that Obama said it best in his address to memorial service in Johannesburg on Tuesday. The Nation is at a standstill this Sunday as shops, restaurants, literally everything, has closed in respects for Madiba's funeral happening right now.


"Born during World War I, far from the corridors of power, a boy raised herding cattle and tutored by the elders of his Thembu tribe, Madiba would emerge as the last great liberator of the 20th century. Like Gandhi, he would lead a resistance movement -- a movement that at its start had little prospect for success. Like Dr. King, he would give potent voice to the claims of the oppressed and the moral necessity of racial justice. He would endure a brutal imprisonment that began in the time of Kennedy and Khrushchev, and reached the final days of the Cold War. Emerging from prison, without the force of arms, he would -- like Abraham Lincoln -- hold his country together when it threatened to break apart. And like America’s Founding Fathers, he would erect a constitutional order to preserve freedom for future generations -- a commitment to democracy and rule of law ratified not only by his election, but by his willingness to step down from power after only one term."

Politics in Mourning

As hundreds of spectators gathered in the soccer stadium in Johannesburg to honor a legend and hear the comforting words of powerful people, the citizens of South Africa wasted no time sharing their feelings towards the current President Jacob Zuma. Upon hearing his name or seeing him rise to speak the audience shared their distain, with heckles and booing in numbers too great to be ignored by anyone. It is easy to see that Zuma is not held in the high esteem that Mandela was and that Zuma's legacy pales in comparison to his predecessor. While the timing may have been inappropriate in light of the circumstances, there were no other outlets for the people to express their feelings. 

To compound the insults directed at the current president at the funeral this morning I noticed subliminal belittling. While South Africa utilizes it's own national sign language, at the funeral the interpreters were undeniably signing in American Sign Language. And as I watched them, out of habit from attending a deaf school myself for 4 years, my jaw dropped when I saw what the interpreter called the president in his "sign name". Instead of "President Zuma" the interpreter signed, "Prince Stupid". I kid you not, her and 2 other interpreters over the course of 2 hours signed Prince Stupid consistently when referencing President Zuma. And this incident was AFTER Tuesday in which a fraud interpreter used nonsensical gestures to interpret President Obama's speech. Later it turned out that same man had been convicted of rape, murder, and kidnapping, what's happening? Let me tell you these South African Interpreters are a ballsy group of people. 

As I type, they have laid Madiba to rest after a procession of 450 people trailed out to the grave site between rows of military personel. "I don't think all the good he's done will go into that grave..." said the reporter. And neither do I. South Africa is committed to carrying on his legacy of equality, nonviolence, and love. It has been a surreal experience to be here living in South Africa while the nation mourns their loved leader. An experience I am grateful to be apart of.


Rest in peace Tata Madiba. You are loved by your people and the world.


"It took a man like Madiba to free not just the prisoner, but the jailer as well to show that you must trust others so that they may trust you; to teach that reconciliation is not a matter of ignoring a cruel past, but a means of confronting it with inclusion and generosity and truth. He changed laws, but he also changed hearts.

For the people of South Africa, for those he inspired around the globe, Madiba’s passing is rightly a time of mourning, and a time to celebrate a heroic life. But I believe it should also prompt in each of us a time for self-reflection. With honesty, regardless of our station or our circumstance, we must ask: How well have I applied his lessons in my own life?"

Township Adrenaline

I love my job. Love is an understatement. I'm obsessed. All I think about is going to work, and staying at work when my shift ends (Except prenatal day, but I'll get to that).


It's been a fascinating and eye opening two weeks. Each crack of dawn when I arrive at 6:50 in the morning I'm filled with anticipation. Brimming with questions. Who will I see today? What will I see? How much can I do for this patient in the time I have with them? How much impact can I have on their life?

In two weeks I can't begin to list the things I've seen... So here's a brief list of some personal highlights. (Luckily, I've been keeping notes each day when I come home of my experience).

Day 3: My first day in the ER (which is combined with the Injections and Bloods room, and shared by two awesome nurses, Sister Billy and Sister Thomas). Ok, as a brief introduction please imagine two tiny rooms (more like hallways) connected by 3 doors. Each door leads to a bed in the ER room which also has 3 curtains and a counter down the opposite side. In the Injections/Bloods room the three doors are opposite a bench with three tables and a sink. This is where Heideveld treats basically everyone. Need your Hb read? What about blood sugar? Do you have hypertension and need to check your blood pressure? Were you sent here by a doctor to draw blood (for literally ANYTHING: creatinine, HIV viral load, CD4, syphilis, pregnancy? The list is nearly endless I promise you)? Do you have chest pain and were sent for an ECG? Did your small child fall and hit their head? Is your chest tight? Do you suffer from asthma? Are you having difficulty breathing? Do you receive a monthly injection of anti psychotic medication? Or injections of any other medication? Do you need a vitamin B12 shot? Do you need a shot of antibiotics for that nasty infection? Of course you do. Welcome to the Injection/Bloods room! (They also see ECGs and do Nebulizations)

So my first day here, I was apprehensive. I felt useless amid the chaos. The nurses didn't know who this random person was and I was generally in their way in the tiny, cramped corridor of a room. Eventually I just started picking things up like labels for blood and folders to help organize and before I knew it they were barking orders my way. By the end of my shift, I felt mildly accomplished. The sisters were serious in their work, but no one hates helpful hands in an underfunded, understaffed and hectic ward served by only two people, generally one of whom was at either tea or lunch.

Skipping ahead, I worked two more days in the ER over the coming weeks. The third day I elected to be there since surgery was closed. I'm currently convinced I will volunteer there after my internship ends. On Wednesday I was charged with treating patients myself and keeping track of them. I am allowed to set up Nebulizations, check Hb and blood sugar, blood pressure as well as the Tb and urine testing. The nurses (and patients who have waited longer than three hours) continually ask me to draw bloods, and I refuse on the grounds that I'm not qualified enough. Perhaps one more day in the chaos and they'll just show me and add it to my list of tasks.

Oh, I should add. The Injections and Bloods room is connected to the ER. This means that throughout the day any ambulance patients (or patients who walk in as emergencies) are also admitted here. They always are triaged as higher priority than the Injections/Bloods patients, who must often wait three or four hours before they are seen by the nurses, the line extending down the bench and out the door into the bustling hallway.

The doctor in Dressings next door sometimes sneaks over to help quell the ER's massive overload of patients. He will come by and do some stitching or tape up some minor lacerations before sneaking back down the hallway. I worked in his room on day two after I was done with the circumcisions, and hope to make it back to his room again. It's with him that I was amazed by 30+ year old infections that had seeped deep into the patient's bone, oozing and reeking of decay and bacterial proliferation. We made casts for assault victims who had fractured arms, slathered dog bites that covered a woman screaming in pain in antibacterial ointment, took stitches out of stab wounds and redressed infected gunshot wounds, doused burn victims in salve and gently checked massive c-section incisions one week post surgery. As a person who's background is heavily rooted in microbiology, the Dressing room was my Mecca. The ER, however, combined all of that with the overwhelming excitement and stress of treating 60+ patients in 9 hours.

Also in the ER around 2 pm the doctor from the ID clinic saunters over to check in and lend a hand. He is also one of my favorites at Heideveld clinic. I had the opportunity to sit in on his consultations and speak with his patients on my fifth day, and was enthralled with how his very quiet corner of the clinic functioned. The ID clinic, which stands for Infectious Disease, treats anyone and everyone who has tested positive for HIV.

The clinic is a short pathway (outside) from the chaos at intake, and patients sit quietly in a dark and cool room to be seen by one of the sisters or the doctor. Each consultation is behind a closed door and very private, even intimate. It is in this ward of Heideveld that patients receive incredibly comprehensive care. The doctor discusses their ARV treatment with each patient, checking their blood work and viral loads, chastising some patients for a spike in their viral count (signifying they were not taking their medication properly, called defaulting) while simultaneously praising those who were on top of their regiment and maintaining a viral load that was LDL (lower than detectable limit). We also sometimes discussed their creatinine clearance, which is a calculation done based on the level of creatinine in the blood, the patient's age, weight and gender. The final number describes the efficiency of the patient's kidneys in removing this compound from the body. If they are not effectively removing this potential toxin, the patient must be switched to a different medication.

If the patient was not taking their ARVs, the doctor discussed with them in great detail why they were not. What were their symptoms? How could we best combat those? Once a patient had defaulted on the first line of treatment options, they were automatically bumped to the second line to ensure they did not develop resistance. While this meant getting used to a new schedule of new pills with new side effects, the doctor fully explained their dosage and requirements while reminding them if they defaulted again on this second line, they would be moved to a tertiary hospital to receive their third line medication, as Heideveld currently only dealt with first and second line cases.

Because this ward dealt with all HIV+ patients, they also were equipped to deal with all the other illnesses that may accompany an HIV+ person, including the familiar instances of hypertension and diabetes. Their medication for those conditions (as well as lifestyle choices) were discussed in detail as well, and always prescribed in conjunction with their ARVs, keeping in mind the potential interactions of those drugs.

In the ID clinic I had the privilege of seeing some diverse cases with daunting twists. Here are some of my most memorable:

A 45+ year old woman came in complaining of ... well let's just say the most infected vagina I have ever seen. Seriously, she couldn't even sit down. While discussing what antibiotics to prescribe for such an advanced infection, I learned that apparently most of the STIs in South Africa are resistant to ciprofloxacin (commonly referred to as cipro). Good to know.

A mother and 16 month old child (who was also HIV+) came in together for general checkup. The mother had defaulted on her ARVs during her pregnancy because of the severe nausea she experienced. In talking with her, it seemed that having a child had given her a new take on life and she was committed to maximizing both her and her daughter's quality of life. No more defaulting for either of them. She also was very keen on staying on top of all the potential threats of being an HIV+ woman, including the need for more frequent pap smears (cervical cancer is more common) and checking for Tb. While it was sad to see such a small child growing up with such a burden, I was glad to see her renewed joy for life. I hope it continues well into the coming decades.

A young (20s) man came in from Tambo Village. He was very tall and threateningly skinny. His voice so quiet we could barely hear him, his breath full of wheezing and rattling I immediately associated with potential Tb. It was obvious he was beyond nervous, vastly intimidated by the world of the ID clinic. Eventually, we sussed out that he had tested positive a year ago and refused treatment. He had been scared, he said. Too scared to deal with the reality of being HIV+. We checked his year old blood work and my heart sank when I saw his CD4 from the year prior was 54. (as a reference generally AIDS is contracted around 200 and treatment with ARVs is recommended anywhere under 500). The doctor guessed that his current number was probably around 10. He was lucky to be alive. Very lucky. Through tears he expressed his desire to start treatment and take it seriously. If he doesn't he will not survive much longer.

The next woman to walk in was equally as heartbreaking. I watched with great curiosity as the doctor filled out the first police report for domestic violence I have seen done in South Africa. He drew the bruises that covered her back, face and arms. No photographs, only sketches on a government form with the outline of a human body. I discussed how in the US the photographs were used as evidence in the trial along with the testimony of the doctor. He agreed that photographs would be preferable, but admitted that in four years of working with these cases he had never once been called to court to give testimony. I asked if the clinic had anyone to contact about counseling or victim support. He said that was given at the police station. (No, I thought, it wasn't. No victim wants to go to the most intimidating place you can imagine for counseling). While the doctor asked all of the required questions from the police report ("were you emotional?" Seriously?), I did my best to encourage her to get away from a man who threw her down and stomped on her for catching him cheating with another woman. She mentioned she had no kids with him, though she was pregnant and at five months miscarried. I wondered if it was his fault.
Later, I brought up my surprise at the lack of victim support in the hospital currently to one of the administrators. I was informed that a social worker comes on Mondays and the construction going on next door would contain a brand new ER and a special rape crisis center. That's great, I thought, but does nothing for the woman I saw today.

The next day I was back in the ER/Injections room, running around helping nurses prep a man who had an epileptic fit in the toilet and gashed his head open, and holding down a child who had gotten something stuck deep in her ear canal. At the end of the day I was exhausted, but so fulfilled.

On Tuesday of this week I was assigned to work consulting room 2. Having no idea what that was, I jogged down the hall at 8:30 am (since I spend each morning helping in the file room or doing triage of patients with no appointments) to find the right ward. I knocked on the door and entered to find a sister seated at a desk with a bed and curtain on the far wall. The whole room itself was nearly as big as the entire ER and there were several chairs, a sink, two cabinets and plenty of open space. It was quiet and comfortable. Nearly serene. Certainly a change of pace from my stint in the ER. I sat down after introducing myself and we discussed her work in consulting room two. Antenatals. From 20 to 36 weeks.

I glanced around the room at her posters on the wall. Options for feeding their newborn for the HIV+ mother. Prenatal information sessions. Graphics on growth and development. Ah, I thought. Prenatals. From all the excitement over pregnant women that I had witnessed at the farm between Mandy and Mandi I was keen to learn more about this strange and highly specialized ward. By the 6th prenatal in a row I was getting antsy. All the discussions were so calm and there was so little movement. And no blood. Or infections. Each woman came in, they discussed how far along they might be and their possible due date before she sat on the bed, exposing her swollen abdomen for the nurse to palpate and measure the length of the fetus. The sister would listen for a fetal heartbeat and inquire about diet and vaginal discharge. Over and over again. Even when a 16 year old in grade 10 came in we had the exact same discussion. Each woman was reminded to take their folic acid and iron supplements to keep their Hb up, and sometimes we would test their Hb to make sure it was still within a normal range.

That's when I really got antsy. We were sharing the ER room's Hb monitor since the ER and consulting room 2 are directly across the hall from each other. Each time I'd get up to take the Hb back to the chaos of Trauma I'd get a sneak peek of what I was missing. The lines were massive. People holding rags to various wounds to stem bleeding, ambulance guys in their neon green uniforms bringing people in, kids screaming and crying while the Injection room filled and filled with disgruntled and sometimes very sick patients. I kept making excuses to go back. Each time I returned to the quiet of the prenatal room I'd imagine what was happening next door.

That day was the first and only day I've ever taken a tea break. In South Africa "taking tea" is basically like going on break to have a quick bit of food or relax in between the start of work and lunch. Tea can last a half an hour or so. Nearly every single sister and doctor and intern and whoever takes tea as well as lunch. Except me. I've never taken either.

Except the day I did prenatals. I took a 30 minute tea.

The next day I went to the ER at 8 am without being asked to do so. My supervisor found me there an hour or two later wiping blood off the floor and filling a nebs mask, laughing at my desire to be in the most hectic room of the whole hospital. Don't make me leave, I thought. I found my place.

I'm sure there will be more stories to come, as well as a recount of my day in minor surgery when we couldn't stop the bleeding.
- Rh

Girls Like Guys Who're Circumcised

I've started working at the Community Health Clinic in Heideveld, a township just outside Cape Town. I've been there two days so far, and am already struggling to know where to start in relaying my experience.

First off, I'll start by saying that it has been fantastic. Overwhelmingly positive. I didn't expect it to begin on such a high note, but since it has, I am reveling in it. My first few hours there I was escorted around the entire facility and to each department, being introduced to all the faces that are fast becoming familiar. My cheeks hurt from smiling and laughing, but in a genuine way. South Africans are like that, full of jokes and gossip, easy to talk to and easy to laugh with.

The next few hours I was tasked to help out in the massive intake room - where everyone's files are haphazardly kept along shelves, ordered numerically... up to a point. I spent the day sifting through the piles looking for names and numbers, hoping to be able to add important test results to their growing files. All of the pathology was coming from a national lab in Green Point, and most often the tests were for creatinine, various thyroid hormones as well as a few STDs (strangely, syphilis was the most common of these). Some files were bursting with paperwork, the outside folder horribly frayed and dilapidated, a hallmark of years of clinic visits. Occasionally, I felt sad when I found test results for one of the disintegrating files - just another paper to add to a stack, sometimes with just more inconclusive results.

The day went quickly, and I was thoroughly amused with the wonderful people of the file room. Bustling back and forth, occasionally shouting banter across the stacks, they kept the mood light while we sifted and sorted. Heideveld is an interesting mix of people. I had known the township itself to be predominantly colored (lighter skinned, Afrikaans speaking) and had assumed that most of the people working in the clinic would be as well. As it turns out, the Heideveld clinic serves a community that extends far beyond its namesake, drawing in patients from many different townships. While many patients are colored, there seemed to be high numbers of black (darker skinned, usually Xhosa speaking) as well as some foreign (usually Zimbabwean or Tanzanian - darker skinned, Shona or Swahili speaking) patients. Even more surprising was that there were a lot of Xhosa speaking black South Africans working in the clinic as well. Both in the file room, and, specifically, in surgery, where I was stationed the following morning.

Without going into too much detail, my day in surgery was entirely about male genitalia.

I attended perhaps twenty five circumcisions, shadowing the surgeon and asking questions about cutting techniques (often times he would switch between a traditional scalpel and one that cauterizes as it cuts), healing, rates of infection and complication, as well as how he felt about the practice in terms of its efficacy against the spread of HIV.

Because that's the real reason that the South African government has begun its campaign to offer free circumcisions to men over the age of 15. There were studies done (the surgeon mentioned Ghana and Johannesburg specifically, though I'm not sure where else) that demonstrated a reduced risk of transmission if the penis is circumcised versus uncircumcised. All of a sudden, the practice has caught on in Western Cape.

Mandy and I had previously joked about the giant billboard we always passed by Mbeki Road that flagrantly read "Girls Like Guys Who're Circumcised" - apparently it wasn't so much of a joke.

However, there are many subtle cultural nuances to this very simple surgery that were exposed throughout the day, and that I found much more fascinating than the simple fact that I spent six or so hours staring intently at flaccid, often bloody, penis.

For instance, while we were both leaning over one particularly intense suture job, I asked the nurse who was stitching about the boys who had come in. It was quite racially segregated, she explained. Black South Africans often have their own rites and rituals when it comes to circumcision, and around 14 years old, boys are sent off into the bush and meet with an elder man who is experienced in making 'the cut'. The entire experience is about moving from boyhood and becoming a man, and is entwined with several other physical hardships and tests of emotional endurance. In contrast, white South African parents (I think she meant mostly in the Western Cape) generally have their boys circumcised after birth, as would be the normative tradition in the United States.

Ahah, I thought, glancing down, that leaves coloreds. Like usual, the colored population falls in the middle, and while they don't often circumcise boys at birth, they don't have a traditional cultural ritual surrounding the practice either. So, instead, they come to the government clinic after 15 years old and spend a few hours nervously waiting and glancing around, becoming best brus with the guy next to them, and sometimes crying through the cutting.

Generally, the men would come in (after getting their folder from the chaos that is intake) and take a seat in the hallway leading up to the surgical theater. There they would wait to be called, one by one, to answer a few pre-op questions (medical history, current medications, age, etc.) and have their blood test and pulse taken. After returning to sit for a bit longer in the hallway, they would be called back in to a private consultation room with a woman who works specifically with HIV/AIDS awareness. I had the opportunity to chat with her afterwards and was thrilled to find out she had previously worked in a clothing factory and had left her job after receiving basic HIV/AIDS awareness and counseling training, feeling the need to help as many people as she could, unable to rest with the notion that South Africa was suffering this epidemic through lack of awareness and because of stigma.

She would take each patient in for a quick consultation and a finger prick. Each HIV test was a simple white cartridge with a control line as well as two antibody markers. Like many similar tests (for you ladies out there, think pregnancy tests) one line means the test has worked (and if no other line shows up, negative). Two lines means positive.

I asked her the procedure if a test read positive and she explained that if the patient knew already of their status and had a CD4 count available, they were simply booked for a different day with other HIV positive patients (without this being common knowledge of course). If the patient was unaware of their status, they were given initial counselling as well as directed toward weekly support groups, given an appointment at a clinic dispensing ARVs as well as sent for a CD4 count. For those of you unfamiliar with HIV/AIDS progression, your number of CD4 expressing T-cells is directly related to how advanced your condition is. T-cells are an integral component to your immune system and its function, and T-cells expressing CD4 help in that fight; lower numbers of CD4 expressing T-cells means your body is less able to combat infection, leading to the development of AIDS.

After the HIV consultation and blood test, the patient was sent back out into the hallway, awaiting his turn to be called to one of the three rickety beds behind makeshift curtains. The curtains, needless to say, didn't offer much privacy, and walking in to see the patient in front of you mid-cutting certainly didn't put them at ease. Worse, however, was the fact that each patient could hear the others groans, cries or occasionally screams of pain just before it was their turn.

After unceremoniously dropping their pants and seating themselves on the bed, the men were each scrubbed from navel to thigh with betadine and the nurse deftly administered a local anesthetic (ligocaine - perhaps a close patent relative of the well known lidocaine in the USA?) directly to the base of the shaft of the penis. Most of the patients found this excruciating, and were quite vocal about their opinion. When the actual cutting began (when the surgeon rotated to that bed), some only tensed and covered their eyes, while others nearly jumped from the bed, screaming in protest. However, they usually calmed down by the time the surgeon was done cauterizing the errant vessels that were seeping blood across gowned laps and preforming the first ventral stitch. And by the time the nurse had taken over for the last few stitches, they were inquiring about post operative care as if nothing had happened, tears still wet on some of their faces. The nurses chalked most of their antics up to psychological pain and the trauma of having their genitalia cut into, though once I did see them administer an extra 2 ml of ligocaine to a fourteen year old boy in quite a panic. I had asked them about what they used to determine how much ligocaine to give each patient, noting that they hadn't taken anyone's weight before surgery, and they simply answered: age. Ahah, I thought again, now I know why some cry more than others.

Interestingly, South Africans tend to say "it's sore" instead of "it hurts" - making it sound quite strange to the American listener. While we may register sore to mean a dull ache, they seem to associate it with the sharp cutting of the scalpel or the pull of a surgical needle and thread. Needless to say, there was a lot of crying, plenty of praying and even some singing as boys from the age of 14 on to men as old as 69 lost their foreskin, were bandaged up and sent home.

- Rh

Prenatals and Cookies

I tell Mandi continually how amazing her life is. She essentially gets paid to hangout with amazing women and their families and prepare them to welcome new life. The inbetween time is filled with caffeine, chocolate, and giant juicy paw paws parked by the water as we leaf through the endless wisdom of Ann Frye. Dates with Ann we call them. 

A typical prenatal lasts about an hour where chit chat and hands on belly action tell a story so in depth it's no wonder midwives have such amazing birth outcomes. 

The typical "musts" of a prenatal with Mandi includes blood pressure readings, pulse, urinalysis, belly measurments, fetal heart tones if the pregnancy is far along enough, and a lovely massage for mommy. These essential pieces of the prenatal foundation really only take about 15 minutes of the hour long appointment. The other 45 minutes are intensely individualized and tailored to each client and their specific needs. It's this undivided attention to detail and personal bonding that makes midwifery care so incredible. Not only is one hiring a care giver for their birth but you are basically hiring a new best friend. The most supportive, loving, knowledgable best friend you've ever known. 

I go back to Cape Town tomorrow, but only for a week! I am back in the Elandskraal woods by the next Friday-ish. I meet with my Midwife International spokeswoman and the other student on Monday, at which point we begin the planning phases of the next chapter in my midwifery saga. 

November 29 I plan on attending a meeting of homebirth midwives in Cape Town who are petitioning the South African Nursing Council to recognize the North American Registry of Midwives' rigorous training and certification requirements as legitimate credentials. With national recognition of this training the Certified Professional Midwives trained in the apprenticeship model can expand their services and help bring a new wave of compassionate, intelligent, and fiercely devoted midwives to the greater community. With rampant abuse in the provincial maternity system and an >80% cesarian rate in private hospitals, women are in desparate need of better options and more comprehensive informed consent. 

We are here to answer the call. 

On the same note I also have exciting news to announce. Mandi Busson on her beautiful organic farm is in the planning phases of building a modest one room birth house on her property with the hopes of serving the marginalized women in her community. Starting very soon we are going to start fund raising and asking for donations to make this very realistic dream come to fruition. Using materials from her property, sustainable building techniques, and unwavering determination, we will build this birth center. 

The future is bright. And we have much to look forward to.

-Mandy 

Homicidal Herbivores

Mandy recently discovered that the hippopotamus, an animal she once considered cute and cuddly, was actually terrifying. Watching her come to this realization, while trapped in a highly unstable and tiny sliver of wood barely kept afloat, was hysterical. So I filmed it. 

But to be fair they do actually kill lots of people... Around 2,900 people per year. 



To put that in perspective here are some statistics on deaths per year due to various things...(source)

lightning: 10,000
texting while driving: 6,000 (USA)
airplanes: 1,200
volcanoes: 845
black friday: 550 (USA)
falling out of bed: 450 (USA)
tornadoes: 60
dogs: 30 (USA)
ants: 30 
sharks: 5
roller coasters: 4 (USA)


So technically it's safer to hang out at an active volcano, next to a shark or in a tornado than with a hippopotamus...

The Delta Nation

With just over 2 million people, Botswana is slightly more dense than Namibia with 3.4 people per square kilometer, though not by much, and it still ranks as one of the top ten least dense sovereign nations. While there were small skirmishes during Botswana's colonial days, independence from Britain was granted in 1965 while the new capital was moved to Gaborone and elections took place on September 30th, 1966. Since independence there have been free and fair democratic elections, and currently the son of the first president (leader of the independence movement who served three consecutive terms), Ian Khama is president. Botswana is currently ranked the least corrupt country in Africa, on similar levels with South Korea and Portugal.

Generally speaking, because Botswana has been so responsible in controlling their mineral wealth and other natural resources, it is seen as a highly desirable place to live. It also has the highest Human Development Index rating in Sub-Saharan Africa. However, Botswana is suffering a major drain because of the HIV/AIDS epidemic. Currently, the adult prevalence rate is 24.8%, the second highest in the world after Swaziland. In 1990, the life expectancy of Botswana was 65 - by 2005 it had fallen to 35 due to the HIV/AIDS epidemic. In 2011, due to massive efforts by the government of Botswana, the US government, the Bill and Melinda Gates Foundation as well as several universities in the US, universal access to treatment was achieved, which free AVRs and testing available to all of Botswana. There is also a nationwide Mother-to-Child Prevention program that has reduced the transmission rate from 40% to just 4%. Since 1997, Botswana has been working hard to reduce the impact that HIV/AIDS is having on their nation.

Fortunately, our time in Botswana wasn't marred by this fact. Instead, we were met with a beautiful country full of hardy, incredibly friendly and welcoming people. My first thought, however, was that they were much quieter than the wonderful people I had come across in East Africa. More reserved, perhaps.

The majority of our trip was spent covering Botswana - traversing the country from West to East. Endless flat expanses of dry Kalahari bush was interspersed with islands of succulent Karoo. 70% of the country is the Kalahari. The Kalahari isn't a true desert like the Namib - it isn't only just one massive wave pattern of shifting sands and scorching dunes. The Kalahari is what's called a semi-desert, and thus has much more biodiversity than one would expect. The word Kalahari is derived from the Setswana word for Kgala meaning 'great thirst' or kgalagadi meaning 'waterless place'. In fact, the great National Park that covers the border between South Africa, Botswana and the edge of Namibia is named Kgalagadi Transfrontier Park, and it is in the great heart of the Kalahari. Nearby to the North is the Makgadikgadi Salt Pan (though seasonally this becomes a wetland) in Botswana and to the West the Etosha Salt Pan across the border in Namibia.

Our first night on the road we were lucky enough to stay in a traditional San Bushmen settlement. After it got dark, when it was finally cool enough to be comfortable seated around the fire, a few of our hosts decided to show us the traditional songs and dances they were trying to preserve. They showed us first the important medicinal dances (or trance-inducing dances) they use to fight illness, to keep their community strong. Afterwards, they treated us to the dances they use for entertainment, to tell stories. All of these are named for animals that figure deeply into their traditional lives and some feature reenactments of hunts.

Traditionally, women sing and clap while seated at the fire while the men dance in a tight circle around them, occasionally stepping out in lines when the story they are telling merits. The dance they preform involves the fast short steps that look almost as though they are shuffling, but with strong, short stomps. From the waist up they are nearly motionless, and they seem to glide across the ground. They wear rattles made from the pods and seeds of trees wrapped around their ankles that emphasize their quick steps and that help keep the rhythm of the dance.

I've put together a short video compilation of that night - in hopes to impart how intricate and unique the Bushmen traditions are. They have lived in this area as hunter gatherers for over 20,000 years, perfecting the art of living in a region that is so unforgiving. Their knowledge of how to survive on just the unique desert flora alone is astounding. In fact, they rarely have to drink free standing water, gaining most of their moisture from specific plant roots under the desert floor. They are skilled hunters, incredible herbalists, and all around fascinating to interact with.

In the video you can also hear a young San man speaking his native language which includes the use of several click consonants.

A massively understudied and under-appreciated group, the San Bushmen (!Kung) have a sophisticated belief system, a vast knowledge of hunting, sophisticated medicinal plant use and, until the recent past, was egalitarian. The !Kung are a gift-giving society, based in supporting their community with gifts and the notion that there needs to be mutual support of their community members. There are approximately only 35 names per sex, and individuals with shared names are automatically considered sisters or brothers, whether or not they are biologically such. After marriage, the family lived in the village of the new wife's family so that she may have support during the transition. Divorce was an acceptable occurrence, and domestic violence was kept to a minimum as the doors of the huts remained open and family members or neighbors could intervene quickly.

Even more astounding is the !Kung practice unassisted childbirth, walking up to a mile away from their village during labor to deliver the child by themselves. The child is placed in a small hole dug in the sand and lined with leaves and the placenta is delivered and placed next to it while the umbilical cord remains uncut. The child is covered in a large leaf and after some time the woman walks to alert other women in her community so that they may welcome the new child in a ritual. If the woman is late in returning then the community may look for her to offer help, but this is said to be rare.

!Kung hunters have also developed a sophisticated system such that no hunter becomes too full of himself or sees himself as more important than other members of his tribe. Generally, all hunters will return to the village claiming to be unsuccessful after days of careful tracking and stalking, while someone else will go search to see if any game was "nicked by an arrow" (the Bushmen hunt with very powerful diamphotoxin-tipped arrows) and fell without the hunters knowing. If felled game is found, then it is distributed evenly throughout the community and credit is often given to the one who made the arrow, not the hunter himself.

Because governments have pushed these communities to give up their nomadic lifestyle to herd cattle or work agricultural lands, men have become more valuable than women, as women are often unable to keep employment as they are kept busy making millet, a sedentary food source, during the day. During this transition, they have also been pushed into European style housing with closed doors, which has drastically increased the rate of domestic violence, as well as the abuse of alcohol.

The overwhelming theme of this entire basin is survival. One of the most prevalent factors in this continual struggle is the lack of staying surface waters. In fact, the only permanent water source comes from the Okavango River, which seeps into this vast plain from the North-west (with it's source 990 miles away in Angola) and eventually consumed in entirety by the Kalahari, the environment being far too dry for the river to survive far enough to empty into an ocean.

The delta that is formed by the Okavango is 150 miles across at its widest point during the flood. The January summer rains that pour down on Angola cause a massive uptake of water by the river that take around four months to filter down into the delta, meaning the water levels are highest during the dry winter months (June-August). During this time the inland delta becomes three times its original size. Because of this, the delta draws a massive influx of wildlife from all over the region, creating one of the largest concentrations of game in Africa. All the fauna of the dry Kalahari depend on these waters to sustain them throughout the dry season. Giraffes, hippos, elephants, lions, cheetahs, brown and spotted hyenas, wild dogs as well as several antelope species all rely on this great cyclical movement of water to survive. There are also around 400 species of birds and 71 species of fish present in the delta.

There are five ethnic groups as well present in the delta, three of which are of Bantu origin while two are Bushmen. When we traversed the Okavango via mokoros, we were guided by Bayeyi polers, who were recognizably Bantu and not Bushmen due to their stature. In general, Bushmen are much shorter and generally have younger, more babyish features.

We spent a night camping on one of the many islands formed in the delta, listening to traditional singing by firelight and gazing up at the incredible view of the cosmos. Stargazing in Botswana is unbelievable, without any ambient light for hundreds of kilometers in any direction the shooting stars, planets and galaxies were clearly visible. I slept soundly. Mandy had nightmares of hippos.

- Rh

The Desert Nation

It's been a week since Mandy and I have been back in South Africa, though I've driven to and from Knysna twice already (a total of 20 hours in the Jeep). I have barely had time to organize any thoughts on the incredible adventures we've had. I start a new job this week, so I am anticipating not being able to focus on anything else for a while as well, so I've decided to take this Saturday to reflect on our most recent journey - a sojourn across Southern Africa. The first installment will cover Namibia!

To help export our experience to readers here in Africa as well as abroad, I've cut together some video footage and decided to bolster our account of the experience with some photos and explanations. In our hurry to document all that happened, perhaps we were not accurately able to portray what exactly was going on.

To start, this map is a depiction of the exact route that we took during the six days we traveled, with one day of travel starting in Windhoek, Namibia (pronounced vindhook for those who are still struggling with the Afrikaans pronunciation) and ending in Livingstone, Zambia.

We awoke for an early flight on Air Namibia (this was a first time flying with them for me) direct from Cape Town (CPT) to Windhoek (WDH) which took just under two hours in the air. The landing was quite intense, with the pilot flying his small plane as if it were a puddle jumper, banking and nose diving at will. I, like usual, napped through it while Mandy had several heart attacks in succession; the usual drill of white knuckling the arm rest while she professes her overwhelming conviction that this is it, we're all going to die. We landed, eventually, and stood in line for immigration, both of us slightly nervous we wouldn't be let into the country. We are always nervous about that. It always feels as though we're troublesome little kids sneaking into an R rated movie or into a restricted area, intent on having an adventure, unsure whether or not we're actually allowed to have an adventure. Needless to say, we were welcomed with open arms into Namibia (phew). 

So, a little background: Namibia is something of a new addition to the maps of Africa, as much of Southern Africa was reorganized/renamed during the tumultuous years leading to the end of apartheid and the dissolution of the dominance of colonial powers here.

In 1840, Jan Jonker Afrikaner (no surprise here, an Afrikaaner from South Africa) established a settlement in present day Windhoek, naming it for the two Afrikaans words meaning wind and corner. Before his usurpation of Namibian nomenclature, the Nama people of that region had referred to the area as Ai-Gams (hot springs) while the Herero people had called it Otjomuise (place that steams), both referencing the twelve springs that are near what is currently the city center. 

After Jonker built a church and laid out some gardens, Windhoek experienced brief prosperity and expansion, though fighting between the Nama and Herero eventually wiped out the settlement, and in 1885 it was observed by a botanist that "only jackals and starving guinea fowl remained under neglected fruit trees". 

In the meantime, the British had taken over Walvis Bay and the Germans in 1884 had declared present day Namibia a protectorate under the name German South-West Africa. Creative, I know. In highly German fashion, they sent over a whole bunch of armed forces and were tasked with keeping the peace between the Herero and Nama while using Windhoek and it's life-sustaining springs in the hot, inhospitable desert environment as a base. 

Often times looked over in this synoptic history of Southern Africa is the fact that this is the time and place the first genocide of the 20th century occurred. The "Herero Wars" were a series of slaughters in 1904-1907 where the Herero and Nama who fled violence were kept from leaving the Namib desert, thus dying of thirst or starvation. There were also reports the German army poisoned desert wells to help speed the process of eliminating two ethnic groups along. Survivors were put in concentration camps (such as the famous Shark Island) and used as slave labor for German settlers. The death rates in these concentration camps are calculated between 69 and 74%. An estimated 50% of the Nama population and 80% of the Herero population was exterminated. An alarmingly sick individual by the name of Eugen Fischer also conducted medical experiments on inmates at the camps (one of his staff members later on was Josef Mengele). This is apparently how Germany practiced for the Holocaust. Too bad no one cared enough about Africa to see it coming in Europe. 

Germany officially apologized for this in 2004, though stated there will be no financial compensation for their actions. Also, only as recently as 2011 did the German government agree to return several skulls taken by Fischer to their homeland to be buried. I highly suggest reading the linked articles. It's only Wikipedia and it's still infuriating. 

In the meantime, a fort was erected, three castles were built and the main road through the city was christened Kaiser Street (though, thank God, it's now called Independence Avenue), and with influxes of German and South African immigrants, Windhoek grew and prospered. 

Then there was a bit of a scuffle back in Europe and Germany wasn't allowed to dream of world domination any more (oh wait, no they still did that, they just weren't allowed to have colonies). Thus, German South-West Africa became South-West Africa and South African troops occupied Windhoek starting in 1915 for five years on behalf of the British Empire. It remained under South African control even after the British left, and was ruled under the racist regime of apartheid until it gained its full independence as Namibia in 1990. Since then, Namibians have felt they have comparatively much less to complain about, reveling in the new, nonviolent egalitarian state that has emerged.

In the following years, Namibia and Windhoek have seen prosperity and development. Currently, Windhoek is listed as growing at about 4% per year (most of which is in informal settlements on the periphery), and had a total population of 322,500 in 2012 (67% Black, 16% White, 17% Colored/Asian/Baster). 

Namibia has a total population of 2,100,000 and thus a population density if only 2.5 for every square kilometer, the second lowest of any sovereign nation after Mongolia. This gives rise to vast expanses of empty. Desert scrub-land along rolling hills for as far as the eye can see, oftentimes without a single person on the horizon. Namibia is vast, harsh and inhospitable dotted with clusters of ingenious survivalists, forging a life from the dry sand and crackling bush. We skipped over the rippling sands of the Namib desert and the eerie ghost towns consumed by dunes on the Skeleton coast during our flight, though I hope to venture back there some day. Instead, we explored the neat suburbs of Windhoek, tucked away along the hillsides, expertly manicured and groomed with the world's oldest grey water reuse system. The purple-flowered relatives of the Jacarandas of East Africa cover Windhoek, and the city feels as though it is an Eden among the desert beyond.

Either they have a poor understanding of English or a very strange sense of humor, which is likely part of the German colonial legacy (source: Trey Parker, Matt Stone)

The air is inexorably dry. So dry, it whisks the moisture away from your lips and your eyes and each of your skin cells without your even knowing. All of a sudden you crave a bath. You find yourself fantasizing about swimming in the ocean, pouring a bucket of water over yourself, anything to revitalize. In all of Sub-Saharan Africa, Namibia receives the least rainfall. The country is flanked by two deserts and the only major relief, the Orange River, demarcates the southern border with South Africa. 

The sun is relentless. The heat shimmers everywhere along the horizon, and it is easy to see you are simply baking in one of the world's most effective convection ovens. The first thing I did was buy sunglasses. 

We left Windhoek the next morning to drive out across the desert. I love the long drives, and I reveled in the tireless landscape. The heat had consumed everything here. Eventually, we arrived at a border post - a simple building and a barbed wire fence - and our passports were stamped yet again. On to Botswana. 

- Rh