Update

Cape Town hasn’t made up its mind whether it wants to be in summer or winter this November. We’ve had a few sunny weeks but for the most part, it’s been one cold front after the other ever since I got here. Cape Townians assure me this is a highly unusual year, but that is of little solace to me: I’m here for one year only—can the weather please just get its act together?

As a consequence of the schizophrenic weather, I was sniffling in bed for most of the last week. My colds are usually traumatic, and this one was particularly catastrophic in intensity. After four days of self-medication, I finally gave in to go see a doctor. I’m feeling fine now, though bit irritated at how I seem to have lost an entire week of my life to the flu-gods. My doctor did turn out to be quite interesting: he claims to have diagnosed the first case of mother-to-child HIV transmission in KwaZulu Natal some 15 odd years ago. Except he didn’t call it KwaZulu Natal, he called it Zululand in a move that dated him more thoroughly than his framed degrees. (KZN is the post-1994 name of a SA province created from an old Bantustan called Zululand.)

Though the last week was relatively slow, the one before that was manic in its intensity. m2m was having its annual strategic meeting series, and I was the designated scribe. At the end of the five day meeting series, I felt as though I have gone through a B-school crash course and a graduate course on AIDS in Africa. I can’t remember the last time I learnt so much about how something real works in so short a time, though car-lab does come to mind. The meetings consisted of the organisation’s top management going through the plans for next year and beyond and brainstorming about ways to deliver PMTCT services in better/faster/more efficient ways. m2m is in the middle of a massive expansion both within SA and into several other African countries, and it is a fascinating time to observe how ideas are launched into action on foreign grounds.

In addition to discussions about how the logistics of the expansion would work (who to hire, when and in what numbers, how fast to open new sites, etc), the meeting went into examining the m2m model: empowering HIV+ women to educate other HIV+, pregnant women. It is a simple model, powerful, scalable and transportable because of its simplicity, because as someone said at the meeting: women talk to other women all over the world. A lot of the discussion was about how best to exploit this fact to help prevent HIV transmission to babies in different cultural contexts. Africa is a big country after all [sic]. Not every country will respond to the model as SA has. For example, in Rwanda, men are very active partners and will accompany women to antenatal visits, something that rarely happens in SA. So we have to think about how to accommodate men into the counselling sessions. In Tanzania, women don’t speak to strangers for two months after giving birth, going deep into rural areas in the meantime. This means we have to come up with a strategy to ensure babies get tested for HIV after they are born. There more examples than there are countries on the continent. The only thing the different situations and contexts have in common is that HIV is transmitted from mothers to babies, and of course, our resolve to help.

In middle of all this action, I snuck away to attend an HIV-TB conference that was being held in the city. Another incredibly informative session: TB has now become the number one killer of HIV+ people in sub-Saharan Africa. It is most common opportunistic infection AIDS patients succumb to, and that is made more dire by the fact the TB has been curable for four decades now. People are waking up to this epidemic-within-a-pandemic, and I did hear some positive notes in the session, in addition to meeting another Princetonian: someday it will cease to amaze me that I can look up from writing down a random fact in some obscure part of the world (southern tip of Africa, say), and see a face from my days in orange-and-black.

At the strategy meetings I learnt about a new study on how ARVs can help children with AIDS, who happen to be the most forgotten demographic of the pandemic. The science in the study was unremarkable, but putting real need into the objective of an experiment is no mean feat. At the TB conference I learnt how TB patients under treatment dislike wearing the protective face-mask because of the stigma attached to it. It is not enough for international aid to send cartons of masks over to Lesotho: the TB problem isn’t going anywhere until the treatment respects the cultural context it is undertaken in.

As I slowly amass all these facts and anecdotes about human disease (and pass them on to you, dear reader), I’m filling in the puzzle pieces of the big picture I crossed the ocean to see: where does a scientist fit into helping poor people live healthier lives? Working at the lab bench? Working in the field? Some combination of the two, or some entirely new alternative? I’ll let you know once I do.

Note 1: I’m going away next week to a conference in Pretoria. My first official business trip—very excited!! Full details to follow.

Note 2: We’re selling the car! We’ve found a buyer and once the paperwork is done, I will be marginally richer and significantly more at peace with my own inadequacies. Hooray.