Interviewing

It's coming to the end of the interviewing season, thank goodness. :) For the last couple of months, with a break for the holidays, Pennsylvania hospital has been interviewing candidates for next year's intern class on Wednesdays, Thursdays and Fridays, about 10-20 4th year medical school candidates each day. It's somewhat interesting to see how a program recruits good candidates.

Of course, the program reputation speaks for itself - either for good or for bad. Word of mouth goes a long way, and during the day, they give the candidates ample opportunity to speak to current residents and interns and ask them questions. I, for one, believe in being completely honest about everything, even if that puts the program in a bad light. Of course, I tend to look at things more positively than others, I think, so I may be putting a good spin on things unintentionally. I think it's a bad sign when a program doesn't give you time to spend with current residents and interns - what are they afraid of?

More interesting to me are the little things that candidates care about that draw them to or away from a program. #1 thing is the food. I can't tell you how many times the subject of food or how well candidates have been treated during the interview comes up or plays a role in their decisions. Logically, this should have nothing to do with someone's decision to join a program, or how good the program is, but if crappy food is served during the interview, candidates notice! It's worth noting that on the days that preliminary candidates come to interview (these candidates are internship candidates that, instead of staying in an internal medicine residency for 3 years, are in the program for one year and then go on to a specialty like radiology or opthalmology), the food is much better because good preliminary candidates are thought of as much more competitive and more difficult to draw to your program.

Other little things include paying for parking, taking you out that night with other residents, etc. If a program goes so far as to pay for other things, like hotel costs or travel costs, that's even more impressive to candidates. I think for most people this plays out during residency too - in the end, many people are concerned not just with the training they receive during residency, but their quality of life during residency which includes all these "little things."

Extending coverage

I am all for providing as many people with coverage as possible. I don't know many people that would say that they are against that, but I am even perhaps pro-universal coverage. It would come at great cost, and perhaps lower quality health care for the top 10% of the U.S. population, but for the other 90%, it would be a great improvement. However, one big problem we would face is the availability of health care.

It's a well-known and well-cited fact that places that have universal health care often have long long lines for care, to the point where people's treatments are suffering. Just as an extreme example, and because this is in the field I am going into, say there is a patient who needs cancer treatment. Cancer isn't something that waits around for you to treat it... if you need to wait 3-6 months before you can begin treatment because all the slots are filled up, it may be too late for you. What was at one point a localized curable cancer may have metastasized by then, making treatment far more difficult and prognosis likely much worse.

A more common scenario is probably one in which people may have to wait even for appointments or spots with primary care physicians - these are the most used and most needed (and arguably the most important) of all physicians for a patient and if health care is extended to a large percentage of the uncovered population, there will not be enough of these doctors. Massachusetts seems to be facing that problem now, as they have mandated that all residents have health care coverage.

Do I think this should stop us from trying to get health care for more U.S. citizens? Of course not... do I think we should take steps to anticipate and prevent this problem? Definitely. What we need to convince more people to go into primary care (whether those are doctors, nurses, etc), but that, ladies and gentlemen, is a whole different post.

ha

Look at this site about what a proctologist is... more specifically, look at the girl they put on there! That's a proctologist? Ha. Or you might get they funny looking guy with the stare. Interesting way of depicting proctologists. :)

Faith in American patients

Today may have restored my faith in American patients. Way back when, I posted about how much better African patients were than American patients. Today was my first day of internship and I was prepared. I was prepared for the gripes from the patients: "My cable TV isn't working!" "I asked for mashed potatoes for dinner, not broccoli!" "I refuse to take that medicine!" "I demand a private room!" And of course, I was not expecting any gratitude or help with the patient care from the families. I was not even expecting the patients or their families to know anything about their own illnesses. I expected a lot of drug addicts, HIV patients, gun-shot wound patients, people with no family support, rudeness, impatience, an air of presumption and expecting things they should expect.

I was surprised. Three of my patients or their families expressed extreme gratitude for my help. Some of them were pretty demanding, but in the end they were grateful for all that I did. A fourth patient started out pretty surly and unfriendly. To be fair, he's been in the hospital for close to 3 weeks, and he's not that much better yet. But after talking to him and joking around with him for a few minutes, he warmed up, and even thanked me at the end for talking to him.

I think in the end, you get what you put into the patients. They may be very demanding (especially compared to Botswana patients), but if you really care and try to help out, they'll see that in you and be appreciative. If you don't care about them, of course they're going to realize that and see that in you. Maybe American patients aren't so bad after all. Or maybe it's my first day and I'm still being naive. :)

Free pens and pizza for doctors

A couple of years ago, my hospital banned any sort of pharmaceutical advertising, including free pens, lunches, dinners, prescription pads, drug samples, anything. This was a huge deal. Half the resident lunches were paid for by pharma, and they always coincided with mandatory meetings and conferences, so residents could eat while the attended and knock out two birds with one stone. I certainly understand. For one, without the free lunches at these meetings, residents often don't have time to get lunch! They don't even take the time to go the cafeteria and grab something to go. Even from an outsider's perspective, I think this is understandable - why feed yourself when you could work more on your patients and provide better care? Perhaps even save a life? Secondly, residents do not make a lot of money. They make about $40-45K a year ($30K after taxes), and many of them have $200K in debt after medical school. They haven't saved anything for retirement yet, and some of them have kids and families to support, so the loans are often just gathering interest during residency. So actually, these free meals were a source of income for the residents! Sure you can bring food and eat cheaply (and be much more healthy too) but the average resident does not have time to do this. The alternative is eating at the cafeteria or elsewhere, where an average meal probably costs $5-7. However, if you eat a free lunch off of the drug company (which usually is just pizza or ordered in chinese food or sandwiches), you save that money. You may even have enough left over for dinner if you're working late, which you usually are. Taken over a week, that's $20-$30 you save. Taken over a year, that's $1000-1500 you save, which for a resident, is a lot of money.

Despite these reasons, I've always been hugely for this. I've always thought these free pens and everything else could easily influence (hopefully subconsciously) doctors' prescriptions of these drugs. For example, say you want to prescribe a proton pump inhibitor to a patient, and in your line of sight is your clipboard, with "Protonix" all over it. You might not even realize that you saw it, but the next thing that happens is that you prescribe Protonix for your patient, and they're on that for life... not a bad way for the company to get a patient for 30 or 40 years, huh? And it's even worse with the free samples. I completely understand that free samples are how a lot of poorer people get their medications, and I think that's certainly a benefit. However, if you have a sample of drug X, and it works for a certain patient, even after they stop giving out free samples, that patient is probably going to stick with it, even though it might be 10 times as expensive as drug Y. It's also a huge source of medication confusion - so many patients I've seen have switched from medication to medication, for, say, their hypertension. And it's basically because they switch to whatever is being given out for free for that particular month. That is bad medicine, and bad for the patient.

Of course, we never knew if this was true or not. These are just theories. But why would pharma keep doing this if it didn't work, right? I'm sure they've done their research, and I've actually heard statistics from some ex-drug reps about it. So it's real. And hospitals and practices should ban pharma from advertising in their space. Of course, that's just my opinion, and there are plenty of differing views on this.

Here's an interesting recent article by Art Caplan, a pretty well known medical ethicist.

First Call - to Code or not to Code?

I had my first overnight call as an intern. It wasn't too bad. Pennsylvania Hospital is actually pretty nice to their interns. Typically, interns stop admitting around 1 or 2 am if they're on overnight call. Which means they probably get 3 or 4 hours of sleep, which is great! Of course, I spent about 2 hours with my resident doing a paracentesis (sticking a big needle in somebody's abdomen - you usually do it when fluid is building up abnormally in a patient's abdomen, making it all poofy. Yes that's a medical term. Poofy.) and trying to get IV access and blood drawn from a very difficult patient. So I didn't even start admitting until around midnight, and I felt bad, so I ended up doing 4 admissions, which lasted until about 4:30am. Plus there was a code - which is the thing I actually want to talk about that happened that night. I ended up getting only about an hour of sleep.

So the code was interesting - a resident and I are doing admissions in the ED, and suddenly a code call goes out across the hospital-wide PA system. "CRT... CRT... " and it told us the location. Apparently that means somebody was going through cardiac arrest. I found out later that this patient had been doing fine after his surgery and was being monitored by telemetry. That's where they attached a lot of electrodes to a patient's chest, it monitors their heart, and somebody in a centralized location watches a lot of monitors 24-7 to make sure all those hearts are working properly. This person noticed that at 1am, this patient's heart suddenly stopped working for some unknown reason and called the code. When my resident and I got in there, there were 4-5 people already there working on the patient and giving CPR. It turns out giving CPR (which at its most basic is simply chest compressions and giving breaths) is the most important thing in bringing someone back from the dead and giving them the best chance of survival afterwards. Somebody had already gotten IV access, and he was being pumped full of fluids, they were attaching a monitor to his chest. His heart was in ventricular fibrillation, which is a type of arrhythmia, that if left untreated, usually leads to death. They shocked him, and he immediately went into PEA, or pulseless electrical activity, which means the electrodes were sensing electrical activity by the heart, but it wasn't actually pumping, and the patient was pulseless. At this point, shocking doesn't help anymore, and you basically continue CPR and start giving all these different types of medications meant to jump-start your heart.

The rule of thumb is that you don't continue to code a person past 10 or 15 minutes because (1) the chance of survival is way too low after that period of time and (2) even if you bring them back to life, they've been "dead" for too long, and their functionality is horrible. There's a good chance they'll code and die again before they leave the hospital. However, in reality, codes often go on for 20-40 minutes, especially in patients where it is unexpected. Time goes super fast in a code, and people are reluctant to give up. This code had gone on for about 17 minutes... people were starting to give up, they'd loss IV access (I actually managed to put a new one in on the foot that lasted about 2 seconds). And then all of a sudden, someone says "I've got a pulse." Crazy. This guy was dead for 17-18 minutes, and then all of a sudden his heart starts working again. And the monitor shows that his rhythm, although not idea, is a workable rhythm, and he's "alive" again, and somewhat stable. All this activity starts up again and he eventually gets intubated (a breathing tube shoved down his throat) and transferred to the ICU. I don't know what happened to him after that - I guess if you follow statistics, there was a good chance he coded again and died.

Afterwards, I finally found out the rest of his story. This patient has esophageal cancer, one of the worst cancers to have. The treatment is surgery - they take out your whole esophagus, which is an extremely hard surgery to live through. Then afterwards, many patients have to go through chemotherapy and radiation, which is definitely no joke either. And after all of that, there's a good chance of it coming back anyways! So even if this patient lived and was stabilized, first of all, he would probably have little to no brain function since he got very little oxygen to his brain for 17 minutes. He'd be a zombie, on life support, for the rest of his life. Even if a miracle happened and he woke up, he'd die of his esophageal cancer pretty soon, or have to go through chemotherapy or radiation, which might kill him too.

So my question is... should he really have been coded? If I were the patient, I would not have wanted that. But not many people think of these things when they're going in for surgery anymore. In many countries, they trust the doctors to make these decisions, but in this country, and in the era of litigation, that's just not possible. Because of this, we waste millions of dollars on codes and life support and everything else. But more importantly, it leads to horrible situations that families have to deal with.

Dylan's triathlon with Team in Training, the Leukemia and Lymphoma Society

My good friend Dylan Rivas started a blog about his training for the Lavaman triathlon with Team in Training, which is part of the Leukemia and Lymphoma Society.

A few friends have done this (I don't think I ever could) and I think it's a great idea - the triathlon is in Hawaii, which I'm sure is absolutely amazing for the participants. They raise a large sum of money, and 25% or less of what they raise goes towards the participant's flight, coaching, overhead, etc. The Leukemia and Lymphoma Society gets the remainder, which is a substantial amount. Moreover, it supports an active lifestyle, which not many fundraisers do!

Here's a haiku in his honor:

Go Dylan Rivas!
Many miles to bike, swim, run
Good luck and have fun

Doctors as patients, part 1

It has often been said that the doctor's working in the hospital are the unhealthiest people within the whole hospital. I think I already made a reference to this in a previous post about doctors exercising. I think I can expand this thought and say that in general, doctors are horrible about taking care of their own health and make horrible patients.

I'm reminded of something that happened while I was in med school - one of the most respected surgeons at my hospital suddenly was diagnosed with lung cancer. He never smoked, it was just bad luck. He had been ignoring his symptoms for years and years, and even though he went through surgery and chemotherapy and his colleagues did everything possible to save him, he was dead within something like 4 months, which is very short, even for lung cancer.

I think there are a few reasons why doctors take such bad care of their own health. One is simply a time factor. When you work 80 hours a week, even if you only work 60 hours a week, it's hard to find time to go to a doctor or dentist appointment. Often, even the time you have off from work is spent catching up on the latest medical news or journal articles, which is necessary to stay current. Moreover, since most doctors have daytime working hours, it's nearly impossible to take time off during the day to make it to an appointment - you have to either cancel your own appointments, or arrange for coverage, both of which are costly, time-consuming and extremely inconvenient for you, your patients, and your colleagues.

Secondly, I think it's the medical culture. Even when doctors are deathly ill, they try to come into work unless it's a risk for their patients. This is partly because calling in sick means that you have to inconvenience your colleagues and your patients, and since doctors don't really get sick days, you have to make up the work at some later date, usually on a day off. Additionally, doctors like to be tough, and seem tough, and illness, even for doctors, is a sign of weakness. As a result, many doctors become trained to ignore their own symptoms, even when they are persistent or become serious.

Finally, many doctors feel that they can treat and diagnose themselves, and don't need to go in for an appointment, even though this is often not the case. By treating themselves, doctors again often ignore or miss important symptoms and miss out on getting valuable input or a second opinion from a colleague. Doctors tend to treat themselves very differently from their patients.

In the end, my point is that doctors need to take care of themselves as they tell their patients to do so. They need to go for their yearly checkups, screening tests, etc and not try to manage it all on their own, for their own sakes as well as to be good role models for their patients.

In a very different way, doctors can be bad patients even when they do seek medical advice... I think I'll leave that for another post...

Scrubs

An interesting article in the New York Times sent to me by my mother-in-law:

In case it won't let you read it, here it is:

Should hospital scrubs be worn in public places?

That’s one of the questions asked by my Well column this week, which looks at the role clothing may play in the spread of germs by health workers. The issue of scrubs on the subway and other public places has been raised often by readers of the Well blog.

“I cringe every time I see a medical professional on the subway in their scrubs, which is a regular occurrence,” writes reader A.K.

“What drives me crazy is the sight of someone wearing scrubs while shopping for groceries, going to the post office, picking up their kids from day care, and so on,” writes Jenny, a nurse. “Someone wearing scrubs has been around germs all day. That person is too lazy to keep their patients’ problems away from you, and now they’re handling the apples and cereal boxes that you or someone you love may handle next.”

As my story explains, there’s no evidence that wearing soiled scrubs out of the hospital poses a threat to the public, but part of the problem is that the issue of physician attire and germs hasn’t been well studied. To read more, read the full Well column here, and then post your comments below.

I think the best part of the article are the comments below it from readers - not surprisingly, I agree and sympathize with the doctors. If you work in an operating room, or somewhere that requires clean clothes for the patients' sake (for example if they are all immunocompromised), even if you wear scrubs to work, you have to change into new clean scrubs at the hospital, which you take off before you leave. Otherwise, scrubs are no different from other clothes (for example a suit) that you wear to the hospital. It's really just a public perception that they are dirty - people wearing nice clothes touch the same patients, do the same procedures, go into the same areas of the hospital as people wearing scrubs. From my own perspective, if something happens to a patient and we have to do something emergent, or there's some blood spilled during a procedure, it is easier to clean scrubs than it is to clean a suit or a nice blouse, not to mention that scrubs are often much more comfortable and allow me to do procedures without restriction or care about my clothes. Although not relevant to the safety issue, I also agree with some of the other comments saying that many non-medical personnel wear scrubs too just because it's convenient, and these people often include janitors, technicians, medical students, researchers, etc. In the end, I guess what would be needed to settle this point is a study looking at people wearing scrubs in the public compared to other medical and non-medical people wearing regular clothes and seeing if there are any differences in "germs", and moreover, even if there were differences in amounts or types of germs, if this actually made any difference in terms of infection rates of people they came into contact with. I doubt anyone is willing to spend thousands of dollars to find something like this out.

Escalation

So it's interesting... when I first moved to Philly, I must have had nothing to do. I mean, sure I was probably kept busy for a bit, getting situated, moving things into my new apartment, and starting med school. Actually, I remember it took me quite a while to get more furniture... For a while, all I had was a mattress, a TV, and a chair that sat in front of the TV. I eventually found what I was looking for either on the street, or at Ikea but it definitely took me 3 or 4 months. I even had people over dinner - I made them sit on boxes and on the floor!

ANYWAYS, the point of this blog is that everything in my life seems to have escalated. I had barely any social life back then. I moved, and I knew nobody in Philly. I probably went out once a week, and med school-related events, and went to watch football games with pseudo-friends, some of whom I would become really good friends with, and some whom I have no desire ever to be friendly with again. Maybe I was studying (although most who know me would probably laugh), but I think I found other ways to occupy my time, and for the life of me, I can't think of what that was back then. Now my social life is so busy, it's a little crazy. Not only do I have friends from med school and ultimate frisbee now, which keeps me busy enough, but I have a significant other to interact and live with, and since his whole family lives on the east coast, and his whole friend base is also here, we have some sort of family function about every 2 weeks, which can often take up an entire weekend! And we're also big hosters and cookers - we love hosting people for parties, dinners, you name it. So we're definitely busy.

Other things have escalated too... I came with what fit into a very small two-door car. Basically my clothes, a TV, some pots and pans. Now we have a two-bedroom apartment, plenty of storage, and we are crammed with stuff. Granted we moved in together so there's two people's stuff crammed into one apartment, but I think more than half of it is mine! And we have tons of stuff in storage space too that we don't even use but don't want to throw away. It's ridiculous.

Maybe moving to a new city will be good - it'll be scary but it's a new beginning, and that's pretty exciting. :)

Dinner last night

was really good. I don't have time to cook anymore, so when I do, I really enjoy it. Yesterday we set up an interactive appetizer: spring rolls. I showed people how to soften the wrapper. Then we had an assortment of ingredients you could put in. Bean threads, bean sprouts, thai basil and thai mint were the basis, usually with some hoi-sin sauce. Then you could put any number of additional things - we had enoki mushrooms sauteed with a lot of garlic, green onions, jalapeno peppers, different hot sauces, fish sauce, or dumpling sauce. There may have been more, but it was a pretty good spread.

For dinner, we had three dishes. Chinese broccoli sauteed with oyster sauce, honey walnut shrimp and chicken with cashews. I think everything was a big hit. There were 2 and a half pounds of chicken, and 2 and a half pounds of shrimp. By the end of the night, the shrimp were totally gone, and considering we had 8 people, I think that's pretty impressive. We all stuffed our faces.

Chinese food!

I’ve been dying for Chinese food! So finally tonight, I forced everyone to come with me for Chinese food at J Ma Oriental at the Riverwalk Mall! They all ordered very American dishes (like beef with broccoli, chicken stir fried with vegetables, etc.) and I guess we were planning to eat everything individually. But they came out with all the dishes so irregularly that it became family style. I ordered eggplant and minced pork, which was by far the best dish, and everyone ate mine! But that’s okay – we all ate until we were ridiculously full. We also had these good dumplings in soup, that came with this straw fungus/mushroom thing (which my mom puts in Chinese jai) in the soup.

Going to Gabs with the Senegalese President

I didn’t sleep too well in Jo’burg – must have been the time change. I think I slept only about 2 hours in all. Maybe 3. I definitely kept waking up every hour because I think I was worried that I would miss the pickup to the airport the next morning. The owner of the transport company was the one that came and picked me up! We had a pretty interesting conversation about Johannesburg, and he showed me the Chinatown on the way to the airport.

At the U.S. airport, they had told me to get to the Jo’burg airport 3 hours ahead of time. I was doubtful, but I got there about 2.5 hours ahead of time… nobody was even at the South African Airways desk! They didn’t even open until about 6:30am. And it was a little annoying – I had to wait in line to weigh my bag, and they gave me a little slip of paper with the weight. Then I had to wait in line for the agent to give me a boarding pass. But apparently they can’t do everything, and since my ticket had a different date on it, I had to go to a ticketing agent who put a sticker on my old ticket saying I was traveling on a different date. Then I went back to the first agent to get my boarding pass. I guess it was good that I had a few hours to kill.

Something interesting that happened was that I was trying to figure out how to get to my gate, and the signs weren’t very clear, so I asked a random security guard how to get there. He says “come with me” and I follow him. He took me through all the security checkpoints, bypassing the lines that the normal people had to wait in. And of course, as we were walking to my gate, he was walking with me, and I was sort of trying to figure out how to get rid of him, and he asks for my phone number and to be taken to the United States. I eventually got rid of him by asking for his phone number and saying that I didn’t have a phone number yet. It was sorta funny. :)

My flight was the first flight of the day out of Jo’burg to Gaborone, so I wasn’t too worried about delays and things like that. We were waiting, and nothing was happening when we were supposed to be boarding, and then they kept delaying the take-off of the flight 15 minutes. In the end, we were delayed about 45 minutes, which I thought was pretty odd, given that this was the first flight of the day. It turns out the president of Senegal was on the plane! We didn’t know though, until the end of the 1-hour plane ride. They just called them VIPs. And they made a few people move so that the VIPs could move up front and disembark first. But they did not make me move, so one of the people in the delegation sat right next to me. He knew no English and I knew none of his language (Senegalese). The only thing we had in common at all was French, and my French is really really bad since it’s been about 12 years since I learned it. But he got it across to me that the guy sitting at the very front was very important. So we start to land, and I see one military guy standing alone in a field – I thought that was pretty odd. Then I see a row of 5 cannons (which apparently fired as we were landing), and military people! Then the guy sitting next to me says that all of this is for the guy at the front, and we roll to stop in front of a red carpet that leads to a raised platform. And there are people standing with umbrellas on the platform, and all these soldiers and a military band in front of it. Behind the platform are all these people watching, and press I believe. The guy gets off with all these cheers and the music going, and they proceed to the raised platform to meet the Botswana president, and the Botswana military puts on a whole show with music and marching and everything! It lasted for about 15 minutes, and we watched on the plane. I took a few pictures of it, but had to stop when the flight attendants told me I wasn’t supposed to. :) Dr. Gluckman picked me up, along with the resident, Sarah.

By the time I got to the ICC flats, I was super tired. I think I’d really only slept 4 or 5 hours in 2 days. I had to stay awake for about 2 more hours for this orientation meeting Dr. Gluckman gave us, but once that was over, I took a 3 hour nap while most of the others went hiking up some hill where you have a good view of all of Gaborone, and ended up going to one of the three malls, Game City, where they saw baboons running around!

I eventually woke up, and everyone was still gone. I went to local grocery store, Choppies, which is about a 10-15 minute walk on dirt sidewalks, and bought a few things, came back, and Lisa and Phil were making a yummy vegetarian dinner. Which reminds me, I had bought some beef jerky at the Jo’burg airport – it was so good! And I hung out for a bit after dinner with Lisa, Phil, Josh, and Mike. Tim was there for a bit too but he was leaving the next day. Then I sort of got ready for work as best as I could and went to bed. I slept pretty badly though. I went to bed at 10pm, woke up at 12am, and couldn’t sleep again until 4am. So I didn’t start off my week so well, but I guess I have to expect some of that jet lag.

HIV and AIDS: A Global Health Pandemic

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Product Description
On June 5, 1981, the scientific community received a wake-up call from the CDC regarding a terrible and mysterious new illness that caused immune system failure. A year passed before it had a name: AIDS. Reported infections skyrocketed while science raced to understand a virus that hid among our own cells and mutated quickly. Three decades later, remarkable progress has been made but much more remains to be understood and to be done. In this book, HIV and AIDS: A Global Health Pandemic, Scientific American chronicles the war against the disease from its discovery by Robert Gallo and Luc Montagnier to the most current research on gene editing and potential drug targets. These articles explore where the disease came from, how it works, how it spreads, the search for a vaccine, and cultural and sociological factors. In this book, youll find not only a record of crisis and unprecedented response, but also an essential source to understand the scientific struggle against HIV/AIDS.

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Giant Microbes HIV (Human Immunodeficiency Virus) Plush Toy

Features

• Giant Microbes HIV (Human Immunodeficiency Virus) Plush Toy
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H.I.V. kills CD4 cells, or T-helper cells. Once the immune system is compromised, a person develops AIDS (acquired immuno-deficiency syndrome). H.I.V. is most commonly transmitted by sexual contact with an infected person. Insect bites and sweat carry almost no risk of transmission. Studies show that drying H.I.V. infected fluids can reduce viral presence by 90-99%. There is no vaccine for H.I.V. and no cure for AIDS.Perfect teaching tool for parents, educators, health, medical and science professionals! Great gift for teachers, doctors, collectors, kids of all ages, and anyone with a healthy sense of humor!

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100 Questions & Answers About HIV and AIDS

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Empower Yourself!

100 Questions & Answers about AIDS and HIV provides answers to the most common questions asked by AIDS/HIV patients and their families. Written by a John Hopkins physician specializing in HIV, this must-have resource is for all AIDS/HIV patients, their families, and for high-risk individuals intent on avoiding the disease.

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The San-people resettlement villages

On the way back from the CKGR (Central Kalahari Game Reserve), Jo took us to see a resettlement village of the San-people. The San-people were removed from the Kalahari Desert years ago – maybe not physically, but many of them were told to move and intimated out of the Kalahari and relocated to these settlements where the government provides them with free water and maize, education, roads, and a variety of other free services. So now, the San-people live on 3 main settlements in Botswana, but they really have nothing to do! The government tried to teach them to farm, but historically they are a nomadic group, and there wasn’t much motivation for them to learn farming or keep up with it once the government left. There are no jobs for them, but even if there were jobs, popular opinion is that they probably wouldn’t be interested in taking them. The government provides everything for them – food, water, shelter, so there’s not really a reason for them to work or go to school.

There even seems to be a degree of resentment among the other Motswana – they say that the government gives everything free to them, and if they want to go to college, they’ll pay for them and everything, but they don’t even take advantage of these things! Instead, they sit around all day, and they make this drink called Chibuku. The San-people get free water, sorghum and maize, so they use some of it to make this very strong alcoholic drink. They mix it together, dump in some termite mound for yeast (the more termite mound, the stronger the drink!) and it only takes a day or two to brew. They’re often drunk by noon or 1pm because they just sit around and drink all day and hang out. We visited one of these Chibuku establishments (a bar) and actually got a carton. It’s not bad – a little sour and mealy, but it’s ok. It was definitely very strong. Jo said that after you drink two cartons, you’re drunk. It was only about 11 am and many of them were well on their way to being drunk. It was a little sad.

So how did all this happen? The government made up some excuse about the roads not being good enough in the desert, so the San-people had to move (not that the San-people used roads anyways, or not that the government couldn’t have build the same roads that they built for the San-people’s resettlement out in the Kalahari). The rumor is that the real reason the government relocated the San-people is diamonds, which were discovered in the Kalahari. Some of the San-people have won the rights to move back to the Kalahari, but now the government is saying only those 200 or so whose names were on the legal suit are allowed to move back. So they had to sue again, saying (rightfully so) that they represented all of the San-people. They eventually won, but by that time, the government had been providing so much free stuff now to them that only the older people want to move back. The young ones just want to stay on the resettlement grounds and stay drunk. It’s a very sad story.

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Beats Solo HD headphones are made for music lovers looking for high definition headphones that look as good as they sound. Beats Solo HD headphones combine advanced driver technology and premium design for headphones that deliver legendary Beats by Dr. Dre sound and are lightweight and durable.

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The First Year: HIV: An Essential Guide for the Newly Diagnosed

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This supportive resource explores the next generation of HIV/AIDS drugs and also includes new research on HIV and crystal meth, as well as new insights for the hardest hit population African Americans.

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Absolutely Positive

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• Ten years following its groundbreaking debut at Sundance, the film that first humanized the face of HIV is now available in this Special 10th Anniversary Edition. Neither depressing nor maudlin, ABSOLUTELY POSITIVE is a disarming, often funny film. The tone is set by Adair s wry irreverence and the refreshing directness of his cast. From an initial pool of 125, Adair selected 11 unique individu

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Ten years following its ground-breaking debut at Sundance, the landmark film that first humanized the face of AIDS is now available in this special 10th Anniversary Edition. Simultaneously heart-wrenching and life affirming, ABSOLUTELY POSITIVE is an hon

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The neverending bag of patients

I have had a lot of patients on my list everyday - nearly the max an intern can carry. Today I discharged four patients. That's a lot. But it didn't matter - I admitted another four in the afternoon into night, and there will probably be another one I get there in the morning.

Sigh.