without a microwave

Sometimes I feel like the luckiest man.

I'm in the midst of packing and reflecting on the past year and a half. During this time I've been incredibly fortunate to explore South Africa, visit multiple other countries, receive wonderful visitors, work alongside dedicated AIDS advocates and develop my career. I'm deeply grateful for the people who have contributed to the learning, hard work and fun.

The experience hasn't been without its challenges, but hindsight is not only 20/20 but in this case, rose colored.

For those of you who have kept up throughout the lifespan of this blog -- thank you. Your comments and individual emails have been fun to receive and have often opened the door for further conversation.

Over the weekend I was visiting with some friends who asked, "so what are you doing with all your stuff?" Not quite sure what they meant, I replied, "Well...I'm taking it with me".

They clarified, "Don't you have a TV? Or a toaster? What about your microwave?"

"Well, the place came pretty well furnished, so I'm leaving stuff there. But I never bought a toaster or microwave." Sensing their confusion and wanting to seem conciliatory, I added, "I do have a cheap fan I'm selling."

It was if I had insulted her mother. She stared me directly in the eyes and said, "You don't have a microwave? How long have you lived here? How do you cook?"

Let's just step back and remember how many times I've blogged about my glorious gourmet cooking. Right. Never.

• Toasted sandwiches? Frequently.
• Deep bowls of yogurt +granola? Endlessly so.
  
• White rice and pre-packed curry mix? Weekly.

So why get a microwave if you only have to offload it before long? (note photo of unused bread box and empty space for microwave) And who knew people could be offended that you cook with a few pots and a small fry pan.

I think this is a small lesson for this blog. For many US readers, my travels and work may seem a bit unconventional and quite baffling at times. But unlike my confused friend, I just hope the opinions in this blog haven't made you visibly agitated! Thanks for keeping up and entertaining my "Staying Left" mentality.

As a matter of logistics for anyone interested, I'll be leaving SA on Thursday, arriving in Boston on Friday. With a little luck and adrenaline, I'll be 100% for work on Monday.

On every post I've shared a song of the day, something I'm thankful for and something worth reading. My goal was to provide a soundtrack and personal insight to what's rattling around my brain. So as I sign off, its only fitting to end with those same three categories. The first post of this blog in June 2008 ended with a simple sentence that I'm stealing for today because I think its simplicity is appropriate.

Thanks and I hope the journey was fun.

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Song of the Day: Luckiest Man - Wood Brothers
Thankful for: the opportunity to live, work and explore South Africa
Worth Reading: still more work to be done.

late to the fight

Approximately 330,000 people died from HIV/AIDS while the South African government denied that the HIV virus caused AIDS.

With this disgusting history, its laudable that President Zuma took center stage today to deliver a message of government support, openness and personal responsibility for HIV.

In his speech to the nation, President Zuma urged South Africans to get tested, engage in safe sex, encourage friends to seek treatment and support those who are sick.

With all the myths surrounding HIV, you'd think that Zuma would address them. In fact, he once claimed to have slept with an woman living with HIV/AIDS but wasn't worried since he took a shower after to wash off the HIV. Wouldn't it be a more powerful message if he clearly said, "I once held beliefs about HIV that were wrong. You can't cure HIV with garlic, you can't wash it off with a shower and virgins don't cure it either."

The good news is that South Africa is coming into the 21st century. People with tuberculosis, who are pregnant or under 5 years of age will now be fast-tracked to get AIDS treatment. To balance this treatment shift, President Zuma also repeated this year's theme "I am responsible, we are responsible, South Africa is responsible".

While invoking South Africa's history of apartheid, President Zuma committed to what no other South African president had done. He said, "At another moment in our history, in another context, the liberation movement observed that the time comes in the life of any nation when there remain only two choices: submit or fight. That time has now come in our struggle to overcome AIDS. Let us declare now, as we declared then, that we shall not submit."

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Song of the Day: M79 - Vampire Weekend

Thankful For: pretzels + cheese

Worth Reading: funny South African political puppet video

what a waste

You can't really blame the guys. I know I've often been in a bind when wondering, "gee, what should I do with 300 tons of medical waste? Oh right, I'll just dump it in a hole -- that should do the trick."

South Africa's second largest medical waste management company, "Wasteman", (should have checked the meaning first, guess its appropriate) was raided on Friday when authorities found 300 tons of waste, including body parts, fluids, and needles dumped into shallow trenches.

The media in South Africa are all over the story and slamming Wasteman left and right. But this reminds me of the doping issue in cycling, when the #2,3,4 and 5 top cyclists either were caught doping or mysteriously left cycling without warning. Did anyone think that Lance Armstrong was that much better than everyone who seemed to be doping?

So who is the #1 medical waste management group? Where are they disposing of their waste?

You know the only thing that makes a better news story than 300 tons of medical waste? 500 tons of medical waste!

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Song of the Day: The Dump Truck Song

Thankful For: online shopping and ability to avoid shopping crowds

Worth Reading: I'm for second chances, but thirds? no thanks.

there's no place like home

South Africa feels like my second home. However, its not quite home because its missing a few critical things. Here are the top 10 things I've missed most while being away...

#10: The 4th of July: by far my favorite holiday in the US calendar. When else do you mix sun with baseball/wiffleball, beer, BBQ, ice cream and national pride?

#9: 2008 Elections: I experienced the intense primaries for 2008, but I think the excitement around the Obama presidency was lost a bit here in South Africa. Yes people are proud of this "son of Africa" but I wished I could have experienced this historic event in the US.

#8: Cooking: On the whole, my diet sucks. As I write this its midnight, yet I'm eating a half-warmed bowl of generic pasta mixed with mediocre sauce. I cook a minimal diet because (1) I am only cooking for me (2) I'm not in Joburg enough to feel inspired and (3) I never really bought the proper cooking appliances/utensils to create masterpieces.

#7: Ice Cream: Despite the large number of dairy cows in South Africa, the ice cream is pretty crappy. Aside from an occasional soft serve cone, I generally pass on ice cream here since I'm so spoiled with good ice cream in the US.

#6: Baseball: I'd like to think the Sox's weak performances in 2008/2009 were their way of showing me that my fan participation is important. Spending an evening watching rugby, cricket or soccer just isn't the same.

#5: Home ownership: Just a few months before coming here I bought my first home. And just a few months ago, Lisbeth bought a condo in Maine for weekends/vacation. Its been very hard to not share these places and big new experiences together.

#4: Cycling: There are few things in life more enjoyable than a 30 mile bike ride on a s

unny day. Riding a bike on the "wrong" side of the road in a place you don't know (which is known for traffic fatalities) just doesn't seem like a well-calculated risk to take.

#3: Performing music: Some of life's best memories have included my guitar, a Harpoon UFO, a top 40 rock song and a bar full of eager singers. With plans to start a band playing original music, Chris and I will continue weekly gigs in Boston just to keep the good times rolling.

#2: Family: Since I've been here, my nephew (Henry) has grown like a weed, my mom has

had two knee surgeries, my cousins (Erin, Suzanne, etc) have added new tikes to their families and Facebook has given me insight to my other cousins' life in college. I can't wait to rekindle those friendships.

#1: Lisbeth: South Africa's biggest flaw is its shortage of Lisbeth. Without her, this place always feels like a transit stop -- just a holding pen before I am living with Lisbeth again. Despite my cajoling, I think it will take a little more planning to get her to move here. In the meantime, I'm counting the days until our reunion.

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Song of the Day: Mission -- Dispatch

Thankful For: Ashley who I work with
Worth Reading: Vote for Motherboar

I'm a believer

Clinics take time to build. Large grants have lengthy application processes. Recruiting, hiring and retaining skilled staff never ends.

For these perennial reasons, we often ask clinics, "what can you start trying tomorrow with the available resources you have?"

The point is to spur people into action so that they can test ideas, hone in on challenges, proactively problem solve and, after compiling clear evidence, allocate more resources.

Well, I think I can save us a lot of time in the Ekurhuleni District near Joburg by stating the obvious -- we need more places where people can receive AIDS drugs (aka: ARV initiation sites). In the three sub-districts that make up Ekurhuleni, the following number of ARV Initiation sites exist: South has 8, East has 5 and North has 2. This disparity is killing people.

I believe that patient care and the flow of patients isn't much more effective across the three areas, however, look at how their monthly initiations compare to their targets (red line)!

See how the South and East (top two graphs) are close to or meeting their goals while the North (bottom left) is still struggling?

I'm convinced that if the North had more initiations sites we would see a dramatic shift in the number of patients initiated each month. Some of my process-minded friends might inquire if we're doing all we can to maximize the available resources and my answer is "no". But we have a pretty clear answer here to say that giving the North three more ARV Initiation sites would be wildly beneficial to the people living (and currently dying) with HIV/AIDS.

The model we often cite for success is "Will, Ideas and Execution". In other words, you need all three pieces -- leadership, an action plan and implementation ability -- to achieve your goal. But my friend Meera whose work in Rwanda left her saying, "Will, Ideas and Execution and Resources". I have to agree.

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Song of the Day: All the Single Ladies -- Beyonce

Thankful For: my love affair with Microsoft Excel

Worth Reading: Race and Healthcare in Madison, WI

sustainability: more than a buzzword

Its about 95 degrees in Mthatha and I'm waiting for my final flight back to Joburg. As I reflect on my time here, and the work I'm leaving, I'm a bit emotional.

IHI has been here in some capacity since 2005 and in the last two days I've seen real proof that the work goes far beyond our Cambridge-based organization.

This week is traditionally the yearly strategic planing week for RTC (the local partner org here) and its characterized by countless powerpoint presentations that just drag on and on. In the past, I've presented or co-presented the work with South African colleagues.

This year, the presentation was created with minimal input from me, and local staff did the presenting themselves. Leadership from RTC was in full support, encouraging other staff to follow their lead. At the end of the presentation, people were impressed with the team's progress and skills.

From a sustainability perspective, I feel incredibly happy about this. While we may not have fully acheived our clinical goals yet, the local team is skilled and empowered enough to press on. I really have faith that with a little ongoing support, they can really make a huge impact.

So, while my departure has resulted in some tears and plenty of hugs, I think the team here feels a responsibility and ability to carry the torch.

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Song of the Day: Big Empty -STP

Thankful For: air conditioning

Worth Reading: Its Constitutional

thanks but no thanks

These are a few of my (least) favorite things. In continuing this week's "thanksgiving" theme, I'd be happy to never relive the following experiences from living in South Africa.

Pay Day: Have you ever gone shopping they day before or after Christmas? Do you love the chaos, the rude behavior and stock-outs on shelves? If so, then you'll love shopping on the last Friday of the month in South Africa. And some people get clever and use their money to buy something you clearly don't want and try hawking it at a traffic light. How many times have you been sitting at a traffic light and thought, "gee I could really use a manual egg beater right now" ?

Visa: I've always wanted to operate legally in South Africa. But the Dept of Home Affairs doesn't make it easy. While the prospect of being deported has been stressful, at least I've been to Botswana and Namibia!

Accommodation: The Blakeway Lodge in Mthatha was a horrible experience. I re-read the blog post and it was summed up with, "My room smells like it used to be a public toilet – and I don’t mean the “sterile” public toilet smell – I mean the “did someone piss on the rug?” smell."

4am: I am thankful that I won't have a 6am flight every Monday. Waking up at 4am is never enjoyable.

Speed Cameras: In theory, I support speed camera. Low cost + income generation + available police to do other things = good for everyone. But who wants to be watching their speedometer all the time? And who likes getting these tickets?

Diarrhea: Getting diarrhea on the night you learn your family's dog has died ranks up there with worst night ever. Throw in stress-induced TMJ linked to the next day's big presentation and you have the worst week in South Africa.

Winter: Yes, Boston winter is crappy. But try 32 degrees without central heating and a broken hot water heater. You know you're cold when you wake up dreaming of hot yoga at 112 degrees.

Roadside Fires: I'm no longer surprised by huge brush fires that ignite alongside (and often on both sides of) the road. However, that doesn't mean I'm comfortable driving into a think black wall of smoke, hoping that I make it out alive.

Distance: Distance makes the heart grow fonder, its true what they say. But I'd rather take their word for it and not live this way.

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Song of the Day: TIA -- K'naan

Thankful For: finally getting data from the local department of health!

Worth Reading: some welcomed news