Final Days in Africa

On my final morning in Chobe, I again awoke to the sound of tiny paws scrabbling on the thatched roof of our bungalow. I grabbed my camera and rushed outside to see if I could catch the little thug in action and found this little fellow looking quite innocent up on the peak of the gabled roof. The hotel owners call him "Short Tail" and he has a reputation as something of a ne'er-do-well. I didn't get the full story as to how he lost the last bit of his tail, but it clearly wasn't enough to teach him a lesson. Later in the morning we heard a shout from the kitchen and saw him sprinting away, gripping a piece of tin-foil that was considerably larger than he was. One of the cooks came running out after him, with a giant cleaver in her hand. We may have found our answer, gruesome though it was. 

Short Tail

Looking innocent

"Wha-at?"

We didn't have enough time for a true safari before our driver arrived to take us back to the Kasane airport, so we opted instead for a short, guided walk through the brush down by the river. A guide arrived with a large, scary looking rifle and instructed us to walk silently in single-file behind him. After 3 days of being driven everywhere and pampered like a king it was nice to get a little exercise, though I nearly collapsed from the exertion. We watched as a family of baboons slowly made their way down from their roosts in the trees by the river and trooped up the hill into the forests for the day's foraging.

For their own safety, younger children and infants must face backwards while the vehicle is in motion.

Children weighing over 10 lbs may face forwards.

They would be cuter without the red eyes, wouldn't they? Note to self: colored contacts for baboons

Our guide told us how they had witnessed a group of hunters on the Namibian side, where such things are legal, take aim and shoot a large bull elephant through the lung. The elephant had took flight, crossed the river to the Botswana side, and started on his climb up to the safety of the forest before finally succumbing to his wounds. He pointed out the skeletal remains still resting on the hillside.

Elephant bones

From the bottom of the floodplain, looking up towards the lodge, you can see how well the location was chosen.

Muchenje lodge from the river

Our guide spotted a young Tawny Eagle who was looking rather relaxed on a branch in a tree next to the river.

Tawny Eagle with moon

Casual Eagle

Later at the lodge, the troop of baboons came onto the grounds of the lodge to munch on the manicured and irrigated lawn and to drink from the swimming pool. Some of the larger males joined with short tail in causing mayhem in the kitchen and screams and crashes were heard. 

"You finished with this grass?"

I can't imagine the chlorine is good for them

After that we simply lounged on the viewing deck for a while, enjoying my first chance to just sit and relax after nearly 5 weeks.

Chobe River with Namibia in the distance

Young Vervet Monkey

"Where'd you put my banana, punk?!"

"I'm sorry you had to see me like that"

Shortly after, we were picked up by our driver and taken back through the park to the Kasane airport where we caught our transfer back to Gaborone. We spent the night in Gaborone and then did a little souvenir shopping in the morning before heading to the airport for our flight back to the U.S. I took Becky to my favorite grocery store, Woolworth's. We found these juices in "Big 5" flavors. Ironic considering that the original "Big 5" were the 5 most dangerous animals to hunt. Now they've been reduced to children's juice mascots.

Elsa Elephant, Bongi Buffalo, Lucy Leopard, Lenny Lion, & Rosie Rhino

We had a few hour layover in OR Tambo airport in Johannesburg so we did a little more souvenir shopping and had a quick meal. Here is the last shot of me in Africa, after my 5 week adventure.

A little worn out. 

Overall, I will certainly count this experience as among the greatest in my life. I saw so many things that brought me up short and made me think about how incredibly fortunate I am to be living the life I do. I have a job that I love and I can only see it getting better. I have a wonderful partner who adds so much and detracts nothing. When I returned to my residency program, I was so thankful for all of the wonderful people that I get to work with and I am acutely aware of the advantages of practicing medicine in this setting. I have just a year left in residency and the next stage is to apply for Procedural fellowships. I'd like to continue writing, from time to time, as I've enjoyed it immensely. I'll close now with the personal statement that I wrote for my fellowship applications, which was heavily influenced by my trip.

The old man stepped into my tiny examination room, nodding to the local girl who was serving as my nurse and translator, and greeted me in the traditional way. “Dumela rra”, he said -- only it came out as “duwela rra”, the reason for which was revealed when he removed the scarf that was wrapped tightly about his lower face, despite the desultory African heat. He dropped the scarf, demonstrating to me how his lower lip had been neatly excised, leaving his bottom teeth exposed and him unable to completely close his mouth. I flipped through his tattered chart and learned how he had been referred to oral surgery for treatment of a squamous cell carcinoma, which had failed to respond to topical therapies, and that this, presumably, was the result. While I had no doubt that the referral had been the best option open to him, in this country of such severely limited resources, I couldn’t help but feel angry and frustrated, knowing how he could have been spared this situation had a trained cutaneous surgeon been available. He spoke to me through his hand as he described the difficulties he now experienced with eating and how his mouth had dried out and how his teeth were rotting away. As he spoke, I quietly schemed, considering how I might help prevent this from ever happening again.

My first experience with global healthcare was an unexpected trip to Haiti in 2010, following the devastating earthquake that hit their capitol of Port-au-Prince. As incomprehensibly shocking as that experience was, it still kindled a strong interest to continue that work and I have since been to South Africa and Ghana and, most recently, to Botswana via a grant from the American Academy of Dermatology. The grant is awarded to just a handful of dermatology residents or fellows each year and provides them with an incomparable opportunity to work for 4 weeks in dermatology clinics in and around the capitol city of Gaborone. The grant recipients are asked to see patients, sometimes as many as 40 a day, completely without supervision and, for this reason, are usually limited to third year residents or fellows. I was lucky enough to be chosen to go at the end of my second year and the experience of operating without the safety of an attending watching over my shoulder was intimidating, to say the least. The experience was empowering, however, and working in this way raised my sense of responsibility for my patients to new levels and likely resulted in the response I had to the aforementioned patient.

While I understand that making Mohs surgery -- or even quality cutaneous surgery -- available to these patients will be an incredibly daunting journey, I know that getting the highest quality training available to me is certainly the next step. Even though it has been my goal since the beginning of residency to pursue a surgical fellowship, my experience in Botswana opened my horizons to how I might make use of the skills I hope to gain and parlay the opportunities subsequently available to me into a meaningful career.

My residency program offered no protected time for research and there were no requirements to complete any. Despite this, I managed to publish and present my work at several national meetings. It is my hope that a fellowship in procedural dermatology will allow me to continue pursuing the research projects and development of medical devices that I started during residency as well as gain the skills I need to serve the populations that need them the most. In short, the next stage in my career development has been carefully considered and I surely intend to make the best use of the skills I obtain, despite the challenges. Thank you for your consideration.

Here is a picture of the gentleman who inspired me.

Signing off, from Cleveland.

Chobe National Park, Botswana - Part 2

On the following morning, we were woken up at the ungodly hour of 0530 by a sharp rap on our chalet's door. There had been a curious monkey pawing at the thatch of our roof throughout the night and my sleepy brain interpreted this noise as the inevitable monkey attack and I sat bolt upright in bed, prepared to do battle. Becky just glances at me with this amused look and pats me on my cheek as if to say "Oh, my hero", and rolls over back straight back to sleep. I'll just say it's a good thing there wasn't a real monkey attack or she would be in trouble.

After a light snack of tea and toast we hopped in our land rover and headed out into the park, which opens promptly at 0600. The sun is just rising at this point and the animals are not prepared for big, lumbering cars to disturb them. This elephant was lazily munching away at brush by the side of the road and did not appreciate my flash going off in it's face. The guide dismissed the danger but I noticed we moved on pretty quickly after that.

Startled elephant

We had about an hour's drive through the north end of the park, on our way back to Kasane to the boat launch for our day on the river. The sun rose roughly ahead of us on the road and the bush slowly came alive as we drove.

The road to Kasane, through Chobe National Park

We managed to stop for a few interesting sights of animals that you don't normally get to see during the day, like this giant 'Secretary Bird' which spied our car and immediately sped off on two legs like a Looney Toons-esque Road Runner. Apparently they are notorious for being difficult to get photos of due to their shyness. Super zoom to the rescue!

Secretary Bird, not available for dictation

The majority of the park is smallish trees and low scrub, not particularly lush for this time of year, but dense enough to hide animals easily. We also drove through nearly barren areas, where all the vegetation had been neatly stripped from the low scrub. This is what a large number of grazing elephants could do to the landscape, our guide informed us.

Elephants are almost never hired as gardeners

Back in the regular forest, Becky managed to spot a group of large black birds with striking red wattles that were walking around on the ground. Our guide named them Ground Hornbills and explained how to tell the difference between the various types of hornbills. It's quite tricky apparently: "Yellow-Billed Hornbills have a yellow bill, Red-Billed Hornbills have a red bill, and Ground-Hornbills walk around on the ground". Devilishly complex.

Red-wattled Hornbill 

Clever girls

They stalk around and snap at each other and generally reminded me of small, black velociraptors. If they could turn doorknobs we'd probably be in real trouble. They'd probably have to change the name to 'House Hornbill' ("because they walk around your house"), or something.

As we got down towards the river, we were driving along, looking at the various antelope and giraffes and other such meat-on-the-hoof and I spotted this attractive bird perched up in a low tree.

Hawk Eagle

While our guide explained that this was the 'Hawk Eagle' ("because they eat Hawks"... I'm sensing a pattern), I happened to glance down and see this young gentleman stalking silently through the brush.

Ground Cat

Now, up until this point, every lion that I had seen in Africa had been previously gawked at by innumerable groups of rumbling land rovers that were tipped off to it's presence through the network of ranger radios. We were always going to see the lion and I was always prepared to see it, prior to arriving. So, this being the first time that I had spied a lion in the wild, just randomly walking through the bush (but also being my experienced safariing self), I of course pointed and gesticulated like an idiot, blurting "Holy Shit! It's a lion!". The lion, for his part, seemed rather unfazed by the whole affair and watched us cooly while we snapped away with our cameras. Tourists.

"What's that? Oh, more tourists?

"Make sure you get my good side"

"This side too"

"They're all my good side"

I did manage to redeem myself when I happened to spot a second lion off to our left, hiding in the brush, and suavely brought it our guide's attention with a "I say, old boy, I think there may be another of those lion chaps just over there". No. Not really... I really yelled, "Holy Shit! There's another lion over there!". So cool.

"You agreed to marry that guy?"

The lions eventually decided we weren't worth watching anymore and slunk away into the dense brush were we couldn't follow. We drove around a bit, trying to locate them, but eventually gave up and moved on.

We found a group of these attractive looking waterfowl down by the river and our guide dubbed them "Egyptian Geese". One of the guests asked if that was because they migrate down from Egypt and the guide explained that "No, it's because they look like they have eye-liner like Cleopatra", which I actually thought was pretty creative. They could have called it an "Eye-liner Goose".

Egyptian Goose (not affiliated with Egypt)

Here is a big, intimidating looking 'Fish Eagle'. I'm sure you can guess what his diet consists of. I'm sure they were miffed when they found out 'Bald Eagle' was already taken.

Tree Eagle

Here are some young Kudu females, whose heads look far too small for their bodies and ears.

"What?!?!"

Later we went back to the tar road for the rest of our journey to Kasane.

'Zebra Crossing'. Haw haw.

Remember the dead elephant from our drive yesterday? This site was now waiting for us as we drove past.

Elephant briquette

Elephants may contract a fatal form of intestinal Anthrax that is relatively common in the wild. Our guide informed us that when an elephant dies from Anthrax, it's body will be burned by the rangers to prevent scavenging animals from contracting the disease. Even the Ivory is burned as it may also contain the spores.

We pulled off the road briefly to take pictures at a well-known watering hole. A day ago I would have been astounded at the number and variety of animals congregating around this one little area, but now it seemed commonplace for Chobe.

Sable Antelope, Warthogs, and Zebra 

National symbol of Botswana

Warthog couple

Even warthogs need love

We found a big group of these guys by the side of the road. There are 6 different species of mongooses in the park, 3 of which are diurnal and only 1 of which will sit still long enough for me to take a damn picture.

Banded Mongoose

At the boat launch, there was a family of Vervet monkeys that were playfully gamboling around the boats. There was one that had a truncated right foreleg (arm?) and we were told that he got in an altercation with a pitbull and lost the limb in the fight. He didn't seem to be much fazed by the loss, though, as he tussled with his brothers and munched on the tall grass.

"Has anyone seen my other arm? Anyone?"

About to lose a face

Happy family

The boat was a small motorized metal skiff, with just enough seats for 8 passengers with our guide piloting from the back. It was quite comfortable after the bumpy ride in the landrover, though.

The Chobe River by boat

Like a painting

These curious birds were out sunning their feathers on some branches by the banks. They are Africa Darters which are sometimes called 'Snake-Birds' because of their long, thin necks that stick above the water as they swim with their bodies submerged.

African Darter

"Ewww, I'm all wet"

The region of the river that we were exploring had a large island separating the river into two halves. The island was initially contested territory by Botswana and Namibia but eventually was designated the territory of Botswana when it was determined that the channel on the Namibian side was deeper, setting the official boundary between the countries. Botswana has helpfully planted a flag on the island to remind any forgetful Namibians.

Batswana Hippo. And don't you forget it. 

The island is covered with soft grass that is favored by older elephants. This old bull elephant was all by himself out on the island. He would pull up the grass and then whip it around with his trunk to dry it off before stuffing it in his mouth.

Nature's salad spinner

He made for some quite nice pictures.

Here is a family of Hippos, busily munching away. 

Nuclear Hippo Family

"Does this angle make me look fat?"

There was an over-abundance of crocodiles, of all different sizes, lounging on the banks of the river. Some were relatively small.

Young Nile Crocodile 

"I can grow to 20 feet in length and will someday be able to take down almost any animal that strays too close to the water, including small rhinos and elephants"

"I'm awesome..."

Others were giant monsters. 

"I will kill you"

"Seriously"

We found this dead, bloated crocodile that looked like a giant, over-inflated pool toy. 

Anatomically correct pool toy

Continuing the proud, African tradition of naming-by-committee, here is the African Thick-Knee. I'm not making these up.

"Don't look at my knees"

This is a Water Monitor Lizard, which took considerable pains to stay well clear of the water, so I'm thinking they may have missed the mark on that one. 

Possibly misnamed Water Monitor Lizard

I had always thought these were called Water Buffalo, but I was informed that Water Buffalo is actually an Asian species of Buffalo that lives almost exclusively in India. These are more correctly called African or Cape Buffalo.

African Buffalo

There is a huge variety of birds that flock to the river in both the wet and dry seasons. I can't even begin to catalog them all but here is a selection of some of the more photogenic ones.

Great White Heron 

Open-billed Stork

Yellow-Billed Stork

Roller (where did that name come from?)

White-face Duck (aand we're back)

Grey Heron 

African Jacana

We came across an enormous group of elephants that were standing around at the bank of the river, looking purposeful. Our guide explained that they were grouped together like that because this was typically where they would gather to start their swim across the river to the island where they graze throughout the day. They would all mill around aimlessly until one of the older elephants would get up the nerve to attempt the swim and then they would all follow suit. 

"No, you go first"

As predicted, one of the larger bull elephants eventually started wading into the river. He was so large that he never really fully went under the water but the others who followed were quickly submerged. The babies would hang on to the tail of the elephant in front until they got into to deeper waters and then you would just see their trunks sticking up above the waterline. It was an amazing spectacle. 

Like sheep

Brave bull

"Everybody in!"

Completely submerged

Built in snorkels

Almost there

Never even fully submerged

Made it! 

Time for some grass

Some young elephants emerge 

Off to greener pastures

On the island

After watching the crossing for a good 30 minutes and then having a short lunch, our day on the river was regretfully over. We stopped for a few more photos on the way back to the launch and then got back in our vehicle for our drive back through the park. 

Nice weave

Red-billed Ox-pecker 

A baby giraffe and parent

You can't take a bad picture here 

The shy Roan Antelope

Back in the vehicle, we had just a few more hours of driving before needing to head back to the lodge. The gates of the park close promptly at 1830 and there is a sizeable fine if you get caught in the park after dark. We decided to only stop for particularly interesting sites after that. We stopped to ask this baboon for directions who told us where to find some lions.

"Just follow the trail of buzzards"

Here were two giraffes that looked at first to be in a fight to the death, but were actually just play fighting. 

"Let's fight" 

"Let's never fight again"

Pretty soon we came upon the buzzards that the baboon told us about. There were probably around 200 of them circling around or perched in trees.

"You guys smell that?" 

"Smells like something died around here. Delicious"

Sure enough, we soon located a female lion who was so stuffed she couldn't even be bothered to to look up when our vehicle approached. Not very photogenic at all.

"Oh man... I ate waayy too much"

We also found the kill, which was sadly a baby elephant.

It's apparently easier to start from the back

There was also a Black-backed jackal waiting in the shade nearby. We had seen them before, but only at night. It was pretty rare to find one out in the daylight.

"Are you gonna eat all that?"

Not 10 meters away we also found a small family of elephants, which I thought was pretty interesting. I  really wanted to tell them there was a lion nearby but I guess she was too full to be much of a danger to them.

"I am not food"

Nearby was a giraffe who seemed to be posing.

Regal giraffe

We also found a large heard of Sable Antelope which was made up of many females and one large male. The male would walk up behind the female and then use his foreleg to signal that he was ready to mate, as so many of us do.

"Hey, baby"

"That better be your leg"

We also found another member of the lion pride that had taken down the baby elephant. A female was sitting quietly by as her cubs played underneath a bush. The cubs were not available for photos, unfortunately.

Time for a nap

She made some pretty impressive faces for me.

So sleepy 

Grinning

BIG yawn

Very zen

We left her to her nap after a bit and drove on, catching some spectacular views of the island across the river.

Elephants on the march

Migrating Buffalo herd

Young elephants at the watering hole

Then, just when I thought I wouldn't get to see the last, and most elusive, of the Big 5 animals, we happened across a group of vehicles that were crowded around a tree at the banks of the river. Looking up, we caught a glance through the branches of some beautiful spots.

Leopard!

Very shy leopard

We waited around for about 30 minutes for the leopard to move to a better position for photos, but he was never cooperative.

Stupid shy leopard

After that we had a very rushed drive back through the park in order to make it out before dark. We made it through the gate at the western border with only 1 minute to spare. Just in time to catch the sunset back at the lodge.

Sunset from Muchenje

Such an amazing day

Just one more day in Botswana before heading home.
Signing off, from Cleveland.