Moyo

After spending the morning at the hospital in meetings for the project, Michelle and I took a walk to "Zoo Lake" and checked out a restaurant that Prof Dhai highly recommended. The park was nice, although I'm not totally sure that we were following all of the prohibitions listed in the sign. The food at Moyo was described as "modern African" and was excellent. Nothing too exotic but everything was delicious.

Soweto

Today Michelle, Prof Ross & I took a tour of Soweto. The name "Soweto" takes the first two letters from "South Western Township"; it was set up as a temporary housing facility in 1904, housed migrant workers in large hostels in the 1940's, and has not changed substantially until the 1980's (electricity first was put in in 1985, and today many people still don't have it). Click here for the wiki on Soweto. The hostels were only made to house the working males, who would be away from their families for months, and so the structures to this day do not have indoor plumbing. Thankfully, they are being replaced by government-made housing.
Soweto has the reputation of being the place that the poor black people live; sometimes called "the heart and soul of South Africa," it is where the 1976 student uprising took place, where the Africa National Congress (ANC) party (the one formerly headed by Nelson Mandela and in power since 1994), and one of the squatter camps there is the home of the main character in the movie Tsotsi (Academy Award for best foreign film 2005).
Photos:

1. Tuck Shop is a general store
2. the tour company set up a preschool; they basically used a shipping container as the storage for the school
3. ladies doing the wash; you can't see it, but there are also pirate electricity wires running from the power lines- when the authorities cut them, more are up by the next day- not very safe but you have to respect the inginuity
   
4. tires along the road with Soweto in the background; during the anti-apartheid struggle, they had this thing called "tire necklaces"- when an informer on the anti-apartheid organizers was found, they put a tire over his/her neck, filled the tire with gasoline, then torched the person as a sign of what would happen to other informers
5. the tour stopped in to see a soccer tournament that was being sponsored by the English Premier League team Manchester United; Wits U is here in yellow; our tour guide played soccer for many years and told us that soccer in South Africa was generally the black sport whereas rugby was historically the white sport; these days sports are integrated
   
6. then we went to visit an unlicensed beer house & drink what the locals drink- homemade beer... it tasted rather sour
7. our tour guide with some of the local kids; our guide is from and lives in Soweto himself
8. a large wall painting inside of Regina Mundi in Soweto of Mandela, Tutu, Biko et. al.
9. outside Regina Mundi Catholic church; this church was very important during the anti-apartheid era as a sanctuary and meeting place for all of the forces; go here for more of its history
10. inside the church there are still bullet holes in the ceiling where soldiers shot both from outside the church into it and from within the church; our guide told us that they keep the bullet holes as evidence
11. our host for the church tour shows us how the corner of the altar was cracked off when a soldier hit it with the butt of his rifle... the MAIN ALTAR IN THE FRONT OF THE CONGREGATION
    
12. the famous Black Madonna, Our Lady of Soweto
    
13. at a shanty town
14. in the same shanty town; the remaining people are being moved into new houses that the government has constructed nearby
15. the Hector Peterson memorial; Hector was a student killed in the June 16, 1976 by the police during a student demonstration about requiring Afrikaans to be a required language in schools; here is the wiki on Hector; one interesting thing I learned was that Hector's family had changed their name to one that sounded more white in the hopes that their children would be classified under apartheid as "colored" instead of "black;" while Hector was classified as "colored," his sister was "black;" there apparently was a committee that determined what your racial apartheid classification was based on your skin tone and hair (e.g. our guide said that for the "pencil test" they put a pencil in your hair- if it stayed you were black, if it fell you were not)
16. Nelson Mandela's old house
    

Apartheid Museum, wine tasting, ostrich fillet

When you arrive at the Apartheid Museum, they give you a pass- if you're colored you get one pass and if you're white you get another. You enter the museum through different entrances based on your color. As was intended, that went against my grain. The museum was a chronological exposition on the history of South Africa, how apartheid came into being, and how it was ended.
I thought the museum's presentations were balanced; they gave enough information to understand the conditions that led to apartheid and how the system persisted for so long (being dismantled completely only in 1994).
Below are some descriptions from the museum. Steve Biko is the person for whom the bioethics center I am doing research at was named for; he was killed because he was denied medical treatment as a prisoner after severe beatings. A photo of Desmund Tutu, Nobel Peace Prize winner, is also below.
After the museum, Michelle and I ran into our neighbor Carl, a Princeton student here putting together a camp to encourage high school students to go to college. We went to a nearby suburb to meet with some of his co-workers for a drink. We met CJ & Bruno, two MBA students at Cornell & Wharton, respectively, and decided to go to a wine tasting at a nearby Hilton. It was a very good wine tasting- the Shiraz's and Pinotage's were solid.
To cap off the night, we went to Mandela Square for a late meal. I had ostrich fillet- which is more like beef than chicken; it was excellent. However, this Mandela Square was conspicuously extravagant. Although I didn't get a pass, as in the Apartheid Museum, it is true that most of the country can not afford to come to a place like this. On Sunday Michelle and I will go with Eleanor on a tour of Soweto to see what is through the other door. Although the doors no longer have colors as labels, the new doors have income as the criteria.

Holding pattern

The only thing to report is that my fellow research student from Harvard has arrived- Michelle. Besides that, we are waiting on ethics committee clearance from Harvard before we can begin talking to patients.
Here is a picture from the main library and another from the main campus quad of Wits.

As the ship goes down

I was asked to clarify the research question I'm here to study... following is my explanation if you care to get into more details (sorry, no photos for this post!):

Well, I did over-simplify the question a bit for the blog.
The question is really: do people want more access to the first-line drugs, or would they prefer less access to the first-line but guaranteed access to second-line drugs if they become resistant to the first line? This is a little more complicated. When an HIV infected patient needs to go on anti-HIV drugs, we start them on "first-line" drugs (same as you start your first-string players in a game); if they fail because the virus mutates or there is a side effect we can give these patients our "second-line" (which may also fail, but if you don't put them in you forfeit the game).
It turns out that the second-line drugs are ~10-20x as expensive as the first-line drugs. In the US we say "who cares? we can pay so second-line for everybody that needs them". However, in Sub-Saharan Africa, only 1 in 10 people who need drugs get ANY drugs. This is the reason that HIV is a chronic disease in the US but a death sentence for 9 in 10 HIV infected persons in Sub-Saharan Africa.
So, why the heck am I working at a Bioethics center? Well, we have a question about distributing severely limited resources that will determine who lives and who dies. This decision has a very strong moral dimension.
Imagine that you're the captain of a ship (the Titanic 2) that just got hit by an iceberg; it is going down in the freezing Atlantic and your first-mate sheepishly admits that not only are there barely enough life rafts for 1 in 10 passengers... some of the life rafts are also way beyond their life expectancy and so they will certainly sink. Since the supplier Rafts-R-Us never bothered to label which ones are old and which new, we do not know which will sink and which will float. Although an obvious solution is to randomly distribute what rafts they have and accept that some will drown when the bad rafts spring a leak, another solution would be to put an extra life raft aboard some of the rafts in order to give those lucky enough to get on any raft a second chance in case the first raft starts to sink.
This analogy fails because doctors claim that they have an ethical responsibility not to let their patients sink if they get on a raft. Docs would say that all rafts should have a backup; they say this because their contract is with the individual patient and letting the individual patient drown would be abandonment, even if such a policy would overall end more lives.
But what if the passengers were all gathered on the slowly tilting deck of the sinking ship while the band played and unanimously said that they wanted the rafts to be distributed one way or the other? That is what we want to know- 1) whether there is consensus among patients about distributing their drug life rafts and 2) what should we do with that information- does it negate the physician ethic of non-abandonment because you are giving the patients what they would prefer?
Oddly, nobody has ever asked HIV-infected folks in Africa, where HIV has been doing the most devastation, what they prefer as the ship goes down.

In the Zone

"The Zone" is a huge indoor/ outdoor mall/ market in the Rosebank neighborhood. Eleanor (Prof Ross) again kindly offered to spend her afternoon to take me there. There is everything from up-scale jewelry stores to a flea market- of course I wanted to go to the flea market! There were crafts from all over Africa- I especially was a fan of the masks.
There were also several performers of various sorts about the market- click here to hear a 36 second mp3 clip of the wooden xylophone folks pictured below.
The last photo is of Hillsboro, which I can now say I drove through! It's not the best of neighborhoods, but on a Sunday afternoon we figured that it would be fine for a drive-thru. When you see a picture of Johannesburg with a big tower, it is the Hillsboro Tower.

New news and old news

Just saw the Brown homepage put up a little news blurb about the study we just published in the American Journal of Public Health ( brown.edu under "News" or
http://www.brown.edu/Administration/News_Bureau/2006-07/06-175.html ). The photos are of Dr. Pugatch, a Hasbro pediatrician who has been my clinical research mentor.
Also thought to share a magazine article "15 Reasons Mister Rogers Was the Best Neighbor Ever". And here is the video referenced in the article of Mr. Rogers testifying before the Senate about PBS funding here.

The Blind Pig

The Blind Pig is the graduate student pub at Witwatersrand; it's an excellent watering hole that is great for meeting international folks from all over the world at. Click here for the Blind Pig web page. On the web page, the Pig boasts to have members "spanning the entire age spectrum (pretty much) and all major genders."
It reminds me of Brown's Grad Center Bar, except that the Pig is above ground. After spending the day working in my apartment, I met Solomon at the Blind Pig and we watched a tennis match and then the Brazil-England soccer match (ended in a 1-1 tie).
About that strike- well, according to the papers it was as huge as expected and they're calling it the "biggest strike since apartheid". The only report of force seems to be some stun grenades for people blocking access to a hospital in Cape Town. Article here.
On Sunday I'm off to the flea market!