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.