Random Updates

Here's a few different things that I did this week:

1. I had a computer melt-down this week and spent two days getting everything back to working order. Kids, downloading software off the Internet can be a bum trip. Stick to legit sources and don't run anything from strangers.

2. I found out that my license has been approved by the Pharmacy Council. So, I'm now legal to be a pharmacist here. I don't think it will change anything, but the clinic is under less pressure to get a locum tenens (temp pharmacist) if Tami is away.

3. The planning for the HIV clinic at Brown's Farm is on track for July 1. While we'll start small, 10 patients per month, there's a possibility of having over 100 patients by the end of September. It depends on how many people being treated at other clinics decide to come to Brown's Farm. There's a general feeling that most of the people who live in the area will come back quickly because of transportation hassles when they need care.

4. I realized that I did not mention HIV/AIDS treatment in my last posting. South Africa only uses six medications to treat HIV, using two different three-drug combinations. The preferred initial therapy is efavirenz/lamivudine/ddi. If the patient is a womanof child-bearing age, nevirapine is used in place of efavirenz. Second-line treatment is didanosine/zidovudine/Kaletra. There are no other options after that. Abacavir is available but not used. Tenofivir was just approved and will be launched in May. There's been no indication of where it will be used – my guess is it will be at least second-line.

Since a large percentage of people with HIV also have tuberculosis, treatment can be difficult. This is especially true here as an increasing number of TB cases are MDR (multi-drug resistant) or, even more scary, XDR (extremely drug resistant). MDR means that the bacteria are resistant to at least two of the five drugs initially used to treat TB. XDR means that at least four of the medications will not work. The XDR problem is worse in the Eastern Cape, but since so many people move to the Western Cape from the Eastern Cape it's a major concern in Cape Town and the settlements. It is entirely possible that in a few years there will be no effective medications for TB in southern Africa. That will be bad.

5. For those of you in health care, here's a chance to feel good about how much you make. According to today's newspaper, a Principal Pharmacist (Pharmacist-in-Charge) at a government-run Community Health Clinic gets paid R147,000 plus a 15% scarce worker incentive. That makes it about R170,000 total, or $24,300. I made more than that when I got out of school 22 years ago. Compare it to today's starting salaries in the US public sector of $85-90,000 and up. Nurses are paid about R70,000 or $10,000 per year, at least a third of what registered nurses are paid in the U.S. Principal Medical Officers (doctors) of various specialties start at about R335,000, equal to $47,500. It's no wonder why health care workers are leaving in droves for the U.S. and Europe.

Many doctors in the government clinics here are from outside the country (Cuba, India, Pakistan, etc.) or are South Africans fulfilling their required post-graduate community service requirement. Pharmacists are required to work two years in a government facility after graduation. None of them are too happy about it but it's the only way the government has been able to stem the outflow of workers from its clinics.

6. At today's church service the sermon was given by a Presbyterian minister from Pretoria. He based it around a Ugandan saying: “People of God gather the pumpkins.” He said this relates to using one's life to serve God, that when you think you're done you still have to gather pumpkins. He also, though, made a tie to pumpkins as being good for eyesight and removing the blindness to God's love. Me, being the agnostic scientist, thought he must be talking about beta carotene (vitamin A) in orange vegetables. Sure enough, when I talked to him after the service he said his mother always told him to eat his pumpkin, that it would turn his brown eyes white and let him see better. I thought it was a different metaphor for nutrition as religious enlightenment, different than the ones you usually hear (“bread of life,” etc.).

7. Nomasomi update: I bought the “bungalow” on Friday. (It's amazing how they try to make depressing situations here a little more palatable by calling a tin shack a bungalow. I think "bungalow" and I think beach-front cabin in Florida. I need to work on my American biases.) We're supposed to be dissembling, moving, and re-assembling next weekend. So far, the work crew is one person (me) but I have no doubt that things will come together at the last minute as they always seem to. More on that as it happens. I met Nomasomi's daughter last week, and she is a very personable girl, eager to live with her mother. Hopefully, very soon.

8. Lastly, I went to the Green Point market today. It's a fairly large crafts market about a 15-minute walk from my apartment. Most of the items are commercially made, even if you're supposed to think they're not, but they do have some nice hand-crafted items of good quality. Prices are pretty reasonable and haggling is allowed (and encouraged, at least by shoppers). I bought a messenger bag for R70 ($10) that I'm sure would have been at least $20 in America. So, I feel pretty good today.

More to come.