August 15th, 2018 by edwardchristiansen
Posted in Uncategorized|

Profound. Captivating. In-depth. This is what my final post must be. How will it summarize what I’ve learned and best express that to my readers? Usage of action phrasing, colorful verbiage, pattern/intonation… Will it live up to the hype? These questions have been running through my mind since the moment I stepped off the plane in Kansas City Friday after 20+ hours of travel. I was picked up by a colleague who greeted with me with a smile and a hug. “How are you? Are you happy to be home? Tell me what you learned in Africa?”

It is now Monday and I can frankly say these are the first 3 questions every single person has asked me. I shall answer them here so as to best dissuade some others I’ve yet to see from noting my frustration as they’re answered:

1) “How are you?”   I’m tired. Jet lag is real and regardless of my abilities throughout residency to change schedules, it has not been easy. I find myself needing a nap just to get through the day. My stomach has not yet adjusted to the diet and my timing is just slightly off when driving my car. I find myself noting more stimuli (e.g. noises, smells, lights, etc.). I tried to hang out with some friends who came into town and I didn’t last past 10pm! In summary, I am a bit rundown.


2) “Are you happy to be home?” Yes! I enjoyed my experience in South Africa but am very glad to be home. I assume this is a lead-in question to what follows but in truth, what person would say no?


3) “Tell me what you learned in Africa?” Are you kidding me? You want me to summarize what I learned? Thus far, I’ve answered this question with one random story, which leads into another story, and so on, and so on, and so on. While entertaining, it actually does not answer the question originally asked. I shall attempt to answer it in the next paragraphs. But what method should be used to in order to start this?


The Blood Moon


My second opportunity to be social found me in a 4×4 with some colleagues heading north towards Nhlamvu and the bush. We would rent some high class tents which had surrounding accommodations for food prep, a fire pit, and toilets/shower. This was all in celebration of the “Blood moon.” This phenomenon is a complete lunar eclipse and occurs when the Earth comes between the sun and the moon. The red color is caused as small amounts of light from the sun are trapped in our atmosphere. As the light bends around the Earth it falls on the moons surface and produces this coloring. The perfect sight for this just happened to be Africa. We arrived and set up camp. This was a pretty posh campground with actual beds, serious reinforced tents, and a full kitchen. There was a bar and a pool. This was awesome. As night fell my inner pyromaniac came out and I took it upon myself to build an awesome fire. I was also tasked with finding a place away from the light of the campground in the bush to view this eclipse. Multiple trips walking through the bush allowed me to find a great spot. It was a small clearing next to two acacia trees (think every African picture you’ve ever seen). The night was still and the stars bright. A light breeze blew in from the sea and the air smelled of fire. Mars was a fire red and lay beside the moon. As the group convened, I was reminded just how small I was in this vast universe. The event was magical and luckily my colleague Remy got some great shots with his nice camera. The following days were filled with amazing experiences. I helped cook and eat ostrich, made friends with others who joined us there, and visited a combination salt water/fresh water lake. Being in the bush was so peaceful and the experience never forgotten.

The beginning of the Blood Moon

Shadow beginning to have it’s effect on the moon

Almost there

The BLOOD MOON. It was eerily beautiful.

Our awesome campsite with serious tents!

Walking back in the evening with the girls to the campsite

The ladies in the morning…

Me being a pyromaniac!

Makeshift raft on the side of this freshwater lake

Lake Pic #2

The Whole Group



The Sardine Run


Sign explaining the Sardine Run at Maibibi beach earlier in the trip

If you aren’t familiar with the Sardine Run of South Africa, I recommend watching the BBC’s coverage of it. Surely you’ve seen some of the short clips of dolphins breaking large shoals of fish into “bait balls” as they feed. Sardines, or pilchards, swim in large groups in order to improve survival. It was 0630 and I loaded my bags into Rachel’s car. She had recommended I be taken to the closest large town in order to grab a Taxi to the large city of Durban. There I would check into a hotel for the evening, so I could easily make my flight the following day. On my way into rural South Africa and Mseleni, I grabbed a private taxi at my previous hotel and had received a history lesson, gotten lost, and paid out the nose for it monetarily. Rachel said I could grab a group taxi and get to Durban at a fraction of the previous cost. Not being completely ignorant on what I was in store for, my colleagues I spoke with said it would be a good experience for me. And so, there I was in a town called Mbazwana at a large taxi station. It was early and there was a chill in the air. Large taxis sputtered in and out all around. All of these taxis looked similar; circa 2000, all same model…except mine.

The Taxi and my bags

I sat my bags (one of them incredibly large…in fact, I don’t think Samsonite even sells such a large bag anymore as oil prices have increased since it’s last usage in 1999) in front of the “taxi” and waited for directions. As Rachel and I said our goodbyes, she noted the driver was somewhere else, but to just leave my bags and they would be loaded. I was to hop on the bus, and when the driver saw the bus was full, he would leave. As the bus filled up with more and more people and items, my goliath of a bag remained outside. People climbed in and sometimes over others. 2 hours passed and we were still sitting there; my bag remaining outside. Another hour passed and more people piled in. No way my bag was getting in the van with me. I began to think what’d I do if the door was quickly closed and my bag had not been loaded. I was seated in the very back seat wedged between a very heavyset African hairdresser and the window. The trunk door was behind me and I figured I might be sweaty enough to slither out should it come to it. The driver showed up and looked at my bag. He shook his head and looked in his cab. There was no way it’d fit. Well, necessity is truly the mother of invention. The bag was somehow tetris’d in, money collected, and we speed away at 10am! The final count has 18 people, not including the driver, showed into a small tin taxi with my goliath of a bag and others!


This pic does not do this justice but it was tight to say the least!


At the one hour mark, I noticed I couldn’t feel my butt. Having little to no padding there is a negative when one is sitting on a thin rubber seat with a steel bar somehow supporting it as you barrel down the highway. Every small imperfection in the road abruptly reminding you of its presence at each moment. The kind, yet still obese African hairdresser even more pushed up against me as I feel my left leg begin to go numb. The taxi continues, speeding down the road with no end in sight. The terrain slowly changing from flat small rural estates to large open swathes of sugar cane and hills. A strange combination of body odor, tobacco, and stale must permeates the air. There goes the right leg. This is it…this is my personal Hell. And then I realize it; I simply have to survive. My fellow travelers and I are sardines on a run to Durban. After 4 hours, we pulled up to the central Taxi station in Durban and climbed out of our Sardine tin. I blessed the sea breeze and made my way to my hotel. A shower had never felt so good! An experience to say the least, but one I’d rather not have to have again anytime soon.


Real Life


I am pleased to report the total donations collected for this trip will be put towards a very special support group. Called Real Life, this is a part of the Lulisandla Kumntwana program created by Dr. Victor and Rachel Fredlund and is a support group for teenagers living with HIV. In zulu, this means “reach out to the child.” This name is based from James 1:27:


Religion that is pure and undefiled before God the Father is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world.


As I saw during my time in the area, teenagers represent their own challenges. Psychosocial changes become evident and unfortunately many teens choose to “control” the challenges in their life by withholding their meds. This can create further health issues later including viral resistance. Per Rachel Fredlund, “This group has been meeting for some years and it has been great to see these young people grow, develop, and mature. Some have gone on to tertiary studies and are doing really well.  They still keep in touch with and support each other.” She goes on to describe how the group meets once per month and alternating between heavier in-depth discussions and more fun activities. These include boat rides, snorkeling, horse riding, nice meals out, trips to the game reserve, the crocodile farm, and the cat sanctuary. They also have had craft days, cooking days, a newspaper fashion competition, and a dancing day. Twice per year they also have career days for the older teenagers teaching trades and providing information/aid to facilitate educational impact. It is my profound pleasure and honor to give to this crucial group. As its name entails, this support group does just that.



This trip and experience was as much about the people as it was about anything else. Together my faith has been strengthened, compassion and understanding towards other cultures has increased, and my soul has been recharged. While I could not capture all those whom I’ve had the pleasure of meeting, the following will give you an idea of what I had the pleasure of encountering.


Morning coffee and just outside the hospital


Morning at The Fredlund’s. Ahhhh


My morning commute to the hospital


Nightly cooking with Rachel


Singing with the Fredlund’s at Hlulabanthu African Evangelical Church and singing my last phrase “It is well with my soul” in Zulu! An amazing experience



As my search for summation in this, my final blog post, I read numerous articles, books,etc. All seemed to capture aspects of how I feel but never fully encompassed them. The closest I could come is in a sermon by Dr. Albert Schweitzer. Aptly titled First Sermon on Reverence for Life, Dr. Schweitzer captures a necessary duality I once thought I understood.


Desire for knowledge! You may seek to explore everything around you, you may push to the farthest limits of human knowledge, but in the end you will always strike upon something that is unfathomable. It is called life. And this mystery is so inexplicable that it renders the difference between knowledge and ignorance completely relative…

            Reverence before the infinity of life means the removal of the strangeness, the restoration of shared experiences and of compassion and sympathy. And thus the final result of knowledge is the same, in principle, as that which the commandment to love requires us. Heart and reason agree together when we desire and dare to be people who attempt to fathom the depths of things.


I have gained a great desire from my passion for helping others. Herein lies another example of how my desire has opened up new opportunities and knowledge into this “unfathomable” thing called life.

The Public Health Post #5

July 30th, 2018 by edwardchristiansen
Posted in Uncategorized|



As my journey comes to an end, more needs to be discussed in regards to the public health component of this area. And naturally, as my goal is to obtain an international diploma in Medicine AND Public Health through INMED I shall do so here. The CDC has an excellent definition of public health and it’s many idiosyncrasies. It is defined as the science of protecting and improving the health of people and their communities. This is usually done by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. In short, public health attempts to protect the health of entire populations.


The Market at the closest town



Some data on this community and culture is as follows: The catchment area of this hospital is approximated by Dr. Fredlund who has direct and longstanding knowledge of the area. He estimates the catchment area to be approx. 100,000 people and 40km x15km. The average life expectancy has increased with the advent of ARV’s with its lowest being in the early 1990’s. Now it is estimated at age 50-55. Leading causes of death for men continue to be homicide/battery, HIV, TB, stroke. For women: diarrheal disease, childbirth, abuse/battery, HIV, TB, cervical cancer.




As one can see from the aforementioned numbers, infectious disease continues to be a large portion of the illness affecting this community. Since the advent of ARV’s, life expectancy has increased by approximately 5 years. Much education regarding HIV has bombarded the local youth. HIV remains a rather taboo topic however. Forcible rape, teenage sex/pregnancy can still be found in the societal norms. Law enforcement and the courts are underfunded, underappreciated, and overworked. In summary, education is there but acceptance continues to be an issue.



Mseleni Hospital, which was initially started by Dr. Victor Fredlund and his partner, was handed over to the ministry of health in this province once its size and scope became larger. Mseleni hospital has up to 6 clinics which feed directly to the hospital. Outpatient clinics are essentially run by nurses or “sisters” of varying degrees of education and experience. A pharmacy stockroom, PT room, outpatient surgery, and delivery room are all present. Physicians from the hospital visit each clinic 1-2x per week and are delivered and picked up by a hospital-funded bus. Immunizations are given consistently, but without autonomy. Some patients are transported to the clinics. Any testing ordered by the physician requires the patient to travel to Mseleni Hospital (including obtaining an xray).


Mseleni Hospital contains the following wards with a constantly changing amount of beds/patient’s served: Male ward, male TB ward, maternity, well antenatal, ill antenatal, ill neonatal/highcare, well neonate, postpartum, Female ward, post-op step down, Female TB ward, adult high care, pediatric, Outpatient department/Urgent Care.


Funding, Staffing, and Community Acceptability


Funding is always a major issue. During my short stay here, the largest issue seems to be nursing and the funding therein. As many things in Africa, there is a large problem with lack of consistency of payscales. I’ve experienced nurses here having little to no interest in maximizing their efficiency, clinical skills, etc. Depending on the nurse, many wards do not receive medicines as ordered or at all. Ancillary staff seem to be better situated. The OR is surprisingly clean, however hand sanitizer is always at a premium. In regards to community acceptability, patient’s seem to be respectful, and appreciate the care received at this facility. There still exists a component of “old-time” medicine. Many of our patients come in in unexplained renal failure likely secondary to usage of “traditional medicines.” I’ve asked around and the consensus on what this consists of is anything and everything. One example is a cellulitic wound where “scratching” or taking a razor blade to the skin and cutting superficial lines to “relieve the pressure.” Any solvent available which is caustic (think battery acid or bleach) is then rubbed into the skin. Education is a key component at Mseleni as they continue to aid in attending to this community in need.


Only recently have I encountered some of the difficulties with medicine acceptance in this South African community. Please note, I intend to generalize in the following statements. My information was obtained from Zulu inhabitants/peoples who were kind enough to enlighten me on some of there closely held beliefs and customs. Naturally, not all Zulu people here or in other places believe this way. My statements and discussion therein are meant only to further elucidate areas of study to improve public health and do not represent judgments on my, or other’s behalf. With this being said, Zulu culture seems to be grounded in a fear-based system where luck plays a major component. This luck, bad or good, has a great deal to do with ones ancestors. If your prayers to your ancestors do not avail one of whatever affliction is occurring, you are to visit a traditional medicine doctor/shaman. He is able to speak to them and offer a solution to which ever relative is upset with you. Many times this includes sacrificing of animals(usually a goat) and doing something with certain body parts. If this does not work after a period of time, you are meant to return to the traditional medicine doctor and repeat as necessary.


Example akin to what is seen around the area


Questions to be Answered

How does one not demean cultural/religious beliefs while encouraging allopathic medicine and more scientific practices in things such as sanitation, sex/relationships, etc.? Education still needs to be the key to this puzzle. However, where many come with good intent, personal biases, cultural norms, and ignorance muddy the waters of lasting change. Partnership needs to exist between trusted community leaders and a group. Only then can education be effectively implemented.


Why are poverty and illness/ill-health related? Like anything in this world, medicine and medical care is a service and in order to continue employment of millions, encourage the best and brightest/compassionate of us to enter it, an exchange of compensation must be incorporated. 3rd world countries, as well as 1st, continue to struggle with this model or any model therein. Is medicine a right or is it a business?


Poverty has ever-reaching socioeconomic impact not just in medical care. However, ways in which this was particularly evident during this time was in one main example; transportation. Transportation between towns, hospitals, or even homes is poor. There are not enough busses, ambulances, or even taxis to bring care to those in need. Services are directly influenced by this in KwaZulu-Natal region. Ill infants suffering from sepsis wait while a 34yo with a non-emergent URI is picked up in a surrounding village on the way to the OPD. Elderly end stage renal disease, multiple comorbidity patients are discharged from large hospitals in urban areas (with many more resources) back to their villages. This is done by these facilities even with the knowledge she will ask to be taken directly to a rural hospital to receive a higher level of care than can be obtained at home. This creates a drag on an already fragile, underfunded health system further allowing those who require emergent care to wait on chronic/non-emergent patients prior to obtaining medical care.


OPD-Outpatient Department


Summary and Further Musings

Answers to these questions are complex and require continued study and support. This is in the form of large agencies with good distribution networks and staffing, funding from countries/governments/individuals, and caring/compassionate humans of this planet. Frustratingly, the above questions have been asked for far too long and more recent political/cultural trends place world health in the crosshairs of destruction. One of the greatest threats to world health today is Isolationism. Currently, we are seeing a rise in nationalism/isolationism among many of the world countries. As the U.S. makes up a large portion of the WHO budget and other healthcare budgets, this movement threatens to drastically decrease or cut off funding for many of the worlds underdeveloped regions. With a consistently increasing globalized world, isolationism is no longer a solution to any form of protectionism. If anything, it represents a real and present danger to the health of our own citizens and, just as importantly, the citizens of the world.



I am greatly pleased with the public, authentic isolation in which we two, you and I, now find ourselves. It is wholly in accord with our attitude and our principles.  

-Karl Marx

Whirlwind of a week- #4

July 24th, 2018 by edwardchristiansen
Posted in Uncategorized|

What a whirlwind of a week, filled with numerous life-changing memories. The start of my week began on the Female ward and high care. I rounded with colleagues and made some med changes. One patient in particular, who is widely well-known in these parts, had end-stage kidney disease amidst other comorbidities. She is one of the fortunate few in the area who gets hemodialysis. Hemodialysis is what many people in the U.S. are familiar with for patients with renal failure. Blood is removed from the bloodstream, circulated through a dialysis machine to rid said blood of harmful waste-products, and returned/circulated back into the patient. Naturally, this process is incredibly expensive in resource allocation, educational requirement, among many other reasons. Recent budgetary reports put dialysis costs at approximately 1% of the medicare budget! It is estimated hemodialysis costs approximately $100,000 per patient per year. Around these parts, peritoneal dialysis is the mainstay. This patient was 68yo and had other comorbidities including hypertension, diabetes, and heart failure and had been recently discharged from a larger hospital. She had no way of making her many dialysis appointments due to social situations, and told her taxi driver to take her directly to Mseleni where she would naturally be admitted.

The problem patient


None of this would be an issue, however her physicians/medical team in the large city sent her with a list of items to be performed by her “primary care team.” Keep in mind where this hospital is, the types of cases were are facing, and the amount of assets available to us. The list was as follows:


  • A CT scan of the chest in order to “rule out chronic lung disease”
    • A non-emergent CT takes approximately 2-4 weeks to schedule and obtain here. An emergent takes 2-5 days!
    • I would also like to mention she had previously treated tuberculosis and, by definition, has chronic lung disease
    • This test would NOT add to this patient’s quality of life, staging of disease, or life expectancy.
  • A referral for pulmonary function tests
    • Again, there is no benefit obtained from this set of tests
  • A referral for a non-obstructed umbilical hernia to a general surgeon that has been present for 1 year
    • This is something she could live with as it is not causing any pain, other problems, and is quite common.


We did order a repeat CXR which was compared to previous, looked at recent sputum samples that were obtained and negative for TB, as well as a blood test which confirmed a negative test for TB. Suffice it to say, we wrote a letter explaining the workup was a waste of resources and that it could be done at a later time at the patient’s discretion.

Comparing xrays

Tuberculosis is a global phenomenon and epidemic much decreased in the U.S. More than 2 billion people are estimated to be infected with M. tuberculosis. Per the WHO, in 2016 10.4 million individuals became ill with TB and 1.7 million died. Approximately 95% of TB cases occur in developing countries. It is largely associated with pulmonary(lung) component, however TB can occur anywhere. Nowhere is this more apparent here in South Africa. It was only in medical school textbooks and UWorld ?’s I saw central nervous system TB, skeletal TB, TB pericarditis(infection with TB affecting the fibrous sac around the heart, gastrointestinal TB, urogenital TB, etc. Here, numerous children develop the disease in some different manifestations but none more devastating to than skeletal deforming type. Children are frequently left immobile and the lucky ones get a wheelchair.


The rest of the week was a hodge-podge of everything. Thursday, I had the opportunity to spend the day in the OR or “theatre” as it is referred to here. After making ward rounds, Dr. Fredlund and I went to theatre. We had 5 procedures scheduled including a skin graft to a hand due to delayed wound closure, schwannoma(muscle tumor) removal from an arm and fingers, and an abscess drainage from a young boy’s leg. Without being derogatory or defaming in any particular sense, I was surprised to find the nursing to be insufficient, slow, and without any urgency. This results in the surgeon essentially managing everything, including grabbing instruments, managing anesthesia, drips, and vitals. It was really an excellent example of true surgical mastery. Before the last procedure (a hernia repair), a pregnant patient was wheeled into the opposite theatre. The story was she had failed to progress in labor, stalling at 6cm. They were preparing to do a cesear when I asked how the baby was on CTG (cardiotocography- i.e. Fetal heart rate tracing for my American medical colleagues). “Normal and reassuring,” was the response from the physician. “What is she dilated to?” I asked hesitantly as I was sure this had already been discussed. “She was a 6 about an hour ago,” the midwife said frustratingly. Puzzled, I put a glove on and found the patient to be 10cm, fully effaced, and +1 station! (Non-medical translation- she was ready to have a baby!) I asked for the CTG and was handed a small bluish-green plastic thing. Befuddled and confused, I suddenly realized what this was: a fetoscope! It’s a stethoscope for a fetus’ heartbeat! I’d never used one. I was so excited, and the fellow physician snapped one of my favorite pics to date. The patient was taken back to the ward and delivered without complication.


Using the fetoscope with Dr. Fredlund in the background!


On Friday, I volunteered to present on hypothyroidism and it’s relationship with pregnancy. I will admit that this was an already prepared Neonatal Grand Rounds presentation but I attempted to make this relevant to this community. The decision was made to focus on 3 primary things. 1) HAART medications and safety profiles in pregnancy 2) History of iodide supplementation and it’s effect on decreasing rates of congenital hypothyroidism 3) Including thyroid studies as a part of a recurrent miscarriage workup. Some of you may be aware, but I tend not to read off of my slides; I’m interactive! I’m afraid the medical students who were present were slightly taken aback initially. However, after we settled in, the presentation went smoothly and they even asked for a copy of it afterwards.

Hypothyroidism presentation

Presentation #2


On Saturday evening, a group of 9 arrived for dinner at the Fredlund’s home. To this point, I have tried to stay away from making them the story of this blog. This has become increasingly difficult. They are in a phrase; the definition of giving. Victor Fredlund came to South Africa as a mission doctor straight after internship in London. He came with his wife Rachel who was trained as a social worker. They married in 1977.

The Fredlund’s in 1977

The Fredlunds

The man and his hat

Dr. Fredlund graduated from St. Georges Medical School, part of London University in 1979. His wife Rachel obtained a bachelors in History at Royal Holloway College London University and obtained a Master’s in Social Work at Bedford College London University. After his internship at St. Heliers, Shalton, and The Mother’s Hospital as a General Practioner, they moved to this area in 1981 as missionaries. Along with there new 5 month old (one of three in total), Victor and Rachel realized there were many social challenges and began project after project to deal with each. To date, there are too many to mention throughout the years, however a random example is as follows:

  • Christoph Meyer Maths and Science Foundation– offers young people who have performed poorly in maths and sciences to improve and better themselves through dedicated learning, interactive experiments, and specialized/dedicated teachers.
  • Vuka Mabasa– started in 1989; instrumental in placing the first reticulated/piped water in the surrounding community, toilets and sanitation, halls for meeting, helps address poor teacher education in maths and sciences.
  • Mseleni Care and Compassion Ministries- includes Mseleni Children’s Home, Ebenezer Early Childhood Development Center, and Lulisandla Kumntwana(Reach Out to the Child). A community project working with orphaned and vulnerable children, unemployed youth, and youth in general giving psychosocial support, practical aid, accessing tertiary education, and lifeskills training to equip them for life.
  • African Evangelical Church and specifically, Hlulabantu AEC– this was a branch specifically “planted” by the Fredlund’s and now regularly serves anywhere from 50-100 members which come from miles around.


Me hanging a sign for the ECDC for Nelson Mandela Day. On this day, everyone in South Africa donates 67 minutes for volunteerism!


I like how the following was put in a 2016 South African article and will include here:


“His home was never going to be his own: he has probably had 50+ children from the local community live in his house semi-permanently over the 35 years he has been serving the community. Some staying only for months, others for years. Most of these children they nursed through the challenges that kids from broken homes and destitute backgrounds face. Disappointments, suffering, heartaches and tears seem to never be far off from the lives he has chosen to mix his with. Together they have sponsored the school/university fees and living expenses of countless children – a small cost, compared to the huge challenge of keeping the lives of the young people growing up in his house on the path of life. Not only does he have several local children at his table every night but almost always a mix of foreign students or volunteers or anybody else who needs a bed for the night. It’s a conservative estimation to say they probably put up at least one hundred and fifty people per year in their large wooden house –which he built himself!”


Back to the 9 who had come as a part of CoCo’s Foundation(who partners with Mseleni Care and Compassion Ministries). They come to this area to help build homes for orphaned and families in need. After dinner, we gathered in the seating area and began discussing about church the following morning. After 1 cup of coffee and a little nudging, I was asked if I would sing. Dr. Fredlund plays a guitar and regularly sings, and Rachel has a lovely voice and commonly sings as well. I obliged and what occurred was a life-altering experience that I shall remember forever.

Hlulabantu Church prior to service


People starting to arrive from the surrounding villages. The church was quite plain, but lovely nonetheless.


Victor preaching with his guitar




Loading the video of our song here was too large for the blog, so I encourage you to check out the link to it on YouTube.  If you get a mere 5% of the joy this gave me, it will be worth a view.






#3- Maternity care and clinic week

July 18th, 2018 by edwardchristiansen
Posted in Uncategorized|

I like delivering babies…there I said it.  So much so, I did an obstetrics track in residency and delivered as many babies as I could.  One of the major wishes I had when I arriving was to have the opportunity to see the differences in obstetrics here in comparison to “the states.” To start, all the vaginal deliveries here are done by the midwives/nurses.  Every single one!  Instrumentation is hardly used and the “ceasar” rate(remember that means c-section) is higher than one might think!  What did this mean to me; no experience actually delivering any babies aside from c-section.  Instead, my week was full of other teaching moments!


The first day began with some surprises.  I arrived and met up with Dr. Myeni.  A soft spoken, brilliant young physician who had done much of her training at Mseleni Hospital.  I asked where we would start rounding and her response was in the neonatal ward.  Neonatal ward?  This hospital had a neonatal ward?  In fact, they have the capacity for 3 incubators and 3 neonatal beds.  They manage babies 25 weeks old and later here!  They have capabilities I was not expecting.  I saw a 29 week old IUGR(intrauterine growth retardation- AKA a small baby even for being born so early) that weighed 800g when born.  For all my American friends who refuse to switch to SI/metric units, that’s 1lb 12oz.  Over that week, the baby was gaining weight and was being weaned slowly from O2.  Another sick baby was one with sepsis from an unknown source.  The baby had been on the normal antibiotics(ampicillin and gentamycin) and had worsened.  The neonate was placed on imipenem and had been improving.  Throughout all the acuity, the gadgetry, and foreign doctors surrounding these young mothers of severely ill children, it was joyous to see them ALL breastfeeding and doing kangaroo care.

This mother was using a cup and expressed breast milk to feed her septic child


After we would round on the ill neonates, we would head to the next ward where ill antepartum(still pregnant) patients were being housed.  The normal pre-eclamptics, possible early gestation SROM’s were there and stable.  The last female was not anything like I had experienced prior however.  If my nonmedical friends and family will indulge me a few sentences, I promise to explain in better terms following the medical jargon. 🙂  She was a 17 yo G1P0 at ~29wga PMH RVD on HAART, hx of cryptococcal meningitis s/p treatment who presented back to clinic with worsening headache and found to have a re-exaccerbation of cryptococcal meningitis.  Dr. Myeni and I looked over her chart finding her to be relatively stable with a normal daily NST. NONMEDICAL TRANSLATION AS FOLLOWS: A young woman with her first pregnancy, with HIV on medication to control her disease, and in her 3rd trimester has a serious infection in her central nervous system requiring heavy duty anti fungal medications! Now back to the story…Dr. Myeni said she was on amphotericin IV and would need to finish 14 days.  Amphotericin?  The only thing I remember about this horribly strong medication was a mnemonic device from med school; this medication is “ampho-terrible” with side effect reactions during infusion!  It turns out with the rates of RVD, this medication in combination with fluconazole is commonplace! By the way, amphotericin is Cat B! 🙂


The following day, we arrived to the neonatal ward to find all the babies oxygen sats falling.  As I was looking for reasons, I made the discovery the O2 outlets were not working.  Constant power outages plague the developing world and we had multiple that morning.  I quickly asked if we had extra O2 tanks and a few of the nurses went out to attempt to find some.  They returned with 1 large metal tank and 2 nonfunctional smaller ones.  After finding these were faulty, I asked for the nurses to continue searching for some while I hooked up our sickest baby(our aforementioned 800g neonate) to O2 and quickly stabilized him.  This was done successfully and eventually, the nurses returned with some workman rolling O2 tanks to set up.  It felt good to get things done!

This was taken while awaiting the other tanks.


Following rounds, Dr. Myeni and I left for clinic.  Only about 20-30 minutes away, it was still lovely to see some of the countryside. As we arrived, we went to a back consultation room where patient after patient opened the door.  They all carry there own medical records!  There we 3 cases which stood out throughout the week and I will mention them here:


  • 45yo female with newly diagnosed RVD and not yet on ART has had 1 month history of mild abdominal pain, some nausea/vomitting, and non bloody diarrhea.  She was back for a check up following a stool culture.  This revealed necator species or hookworm!  Treatment is mebendazole 100mg PO BID x3 days and iron.  That’s because these creepy-crawlies deplete your ability to absorb iron from your diet.  That’s not one you see everyday in the US!


  • 28yo male with no PMH who was hospitalized following MVA/hit and run in Durban with no noted fractures found presents in a wheelchair for continued inability to move his right leg and pain.  He brought his hospital X-ray where a mid-femur and knee X-ray were done of the R leg.  These were negative.  I asked if they’d done a pelvic X-ray and the patient said no.  I did!  Hmmmm, I wonder what we found.

Superior pubic rami fracture


  • 7 month old female presents with mother with bumps on feet that are pruritic(itchy) for 1 month.  The mother notes she saw a doctor and was given a cream which she has used.  She does not remember the name of the cream. Records indicate it was hydrocortisone cream.  The baby is well otherwise.  Physical exam revealed the following…

Scabies with secondary infection

Scabies of the hand


A few data points for those who might be interested:

  • Total deliveries in 1 month:  160
  • c-section rate:  24%
  • HIV rate of mother’s giving birth:  36%


*Please note per the CDC in 2016, the U.S. c-section rate was 31.9%.


All in all, a great week filled with meaningful experiences and medical/life lessons. Of note, I finally convinced some of my previous flat mates to let me ride along for an outing on the weekend.  They were going to Maibibi beach.  They agreed and off we went in a fellow physician’s 4×4.  Approximately 1 hour later we pulled into a heavily and densely forested area.  We saw some signs that said “Beach” and followed it.

Where was the beach?

We began walking down some wooden stairs for what seemed like an eternity.

Where are these leading?

And then….

The heavens opened



Heaven again


No words


The water was a bit chilly but I waded in.  Checked out the tidal pools which were rather absent of life.  Beautiful nonetheless. A couple of hours here and I was recharged!  We headed back and later watched France beat Croatia in the World Cup.  A great end to a great week.

#2-The great feast

July 16th, 2018 by edwardchristiansen
Posted in Uncategorized|

A few days passed and I began to get the hang of/rhythm of everything. The hospital is located in the town of Mseleni (perhaps why there were many signs on the confusing directions here the other day!). It’s rather rural. Cows and goats commonly cross in front of cars without regard or care. Chickens are free range and commonly jolt across a roadway narrowly missing an oncoming car. I have mainly been living off of items I brought along in my bag. This is inclusive of pistachios, coca-cola, dried cranberries, and twizzlers. My bravery, combined with the likely necessity of running low on supplies, compelled me to venture out passed the gates after 2 days. I passed a small grocery store, herein known as a “tuck shop,” and continued about a mile. Locals passed and said “hello.” The houses are mainly concrete and brick, as well as small in nature. However, they are a definitive step above the thatched homes I was expecting and had noted aside the long highway ride in. Walked about a mile before turning around and heading back. Of note, I did stop in the tuck shop and purchased a 2L of sprite, a few canned goods, bread, and peanut butter. That night, I would eat like a king!

Cracks me up everytime…clearly everything is straight ahead!

Mseleni Hospital is unassuming in nature. Spread out over what must be a few acres, the hospital is at the top of the mountain/hill. The wards are all open air. They are divided in the following manner:

  • male ward (composed of surgical step-down, TB ward, medical step-down, and triage)
  • female ward
  • high care (ICU)
  • maternity and neonatal (post-op, post-partum, healthy neonate, neonate high-care, and ill antepartum)
  • pediatrics
  • OPD (out-patient department-essentially urgent care/ER)

There are 2 OR’s and patients line their corridors ready for a procedure. The schedule in the morning is usually to do a group rounds (ward rounds) and then go off to round on ones respective ward until lunch. At this time, people either go to an outlying clinic or OPD to see patients. Those who know me know my love of flowers and plants. My favorite thus far seems to be right outside the main doors of the hospital. In many ways, it is a perfect metaphor for this landscape.

The perfect metaphor


This morning in particular I was on male ward and following with a rather haggard physician. She’s lovely but had just had a horrible night call and was itching to go home to sleep. She asked if I would feel comfortable rounding on one ward while she did the other. We would then reconvene, and discuss prior to her leaving. I agreed. Luckily, I found the nurse whom I had the previous day and she patiently/graciously guided me through my patients; interpreting, answering questions about protocol, and even telling me what medications are on the formulary. Please note, I realize the audience of this blog is not necessarily medically inclined. For this reason, I will attempt to be as general and non-medical as possible while still allowing for the acuity to be noted by my colleagues in the medical community. Also of note, hence forward RVD (retroviral disease) shall be used in place of HIV. This is because of the social stigma that remains in this community. My patient’s were as follows:


  • 2 schizophreniform’s now stable and on risperidone
  • 1 transfer from high-care with a questionable past medical history from the record. Clearly has systolic heart failure, ESLD, who commonly presents for hospitalization with recurrent pneumonias.
  • 1 RVD with PCP, EF 20%, b/l pleural effusions on xray, and a large heart on xray.
  • 1 severe headache with meningitis ruled out
  • 1 post-op day #2 s/p pleural effusion drainage
  • 1 catatonic schizophrenic
  • 1 amebic liver abscess with erosion into the thoracic cavity status post drain placement


I made some med changes to all the patients, ordered labs, and ordered an ultrasound on the PCP pneumonia with O2 requirement looking for a pericardial effusion to possibly drain. All in all an interesting morning.


Walking back to my room, I ran into a fellow physician who asked if I’d like to help with a “ceaser?” Phonetically see-zur, I found out this is a cesarean section! I jumped at the chance and assisted. Here, one physician runs anesthesia while the other operates. Usually performed under spinal/local injection, they also do “crash csections” under ketamine! Yikes. Most incisions are vertical incisions on the skin. This leaves a rather large scar and is not what I am used to seeing. The csection was a success and I left to return to my room for my peanut butter and sprite feast.


Internet Finally- The First Entry

July 15th, 2018 by edwardchristiansen
Posted in Uncategorized|

Hello to all. I have been trying to do this for the last 12-14 days. For numerous reasons which are less than important, I have been unable to begin my blogging experience. From no internet, to lack of other resources and power, etc. this trip has been a whirlwind thus far. I would be remiss if I didn’t mention the initial aspect of my trip from which most international travelers experience; CULTURE SHOCK.


Having travelled internationally before combined with seeing real poverty in the hollers of appalachia in  Stinking Creek, Kentucky, I felt minimally/moderately prepared for what awaited me in South Africa. Oh how I was wrong! As I flew the 16hr flight into Johannesburg, I prepped for an international airport-type feel. Security was surprisingly well-organized and swift. Having some difficulty finding my small regional flight to Durban, South Africa, I wandered rather aimlessly around the large airport. After finally finding the terminal, I boarded a plane and flew the remaining hour to Durban. I found a taxi and proceeded to my hotel for the evening, as it was 9pm already. I stumbled into a rather unassuming hotel and grabbed my room key. Exhausted, not acclimated, and annoyed by the 20+ 13-15 year olds that composed an international children’s choir on my 16hr flight(oh how my patience was tested), I stumbled to my room. As I opened the door, my grouchiness worsened. All I see is a kitchen and a couch…where’s the bed? Turns out 160Rand(~$12) gets one a two-story, two bathroom apartment. Ahhhhh. Suffice it to say, my nights sleep would be well-appreciated for the following day I was set to travel to Mseleni Hospital by taxi.


After a lovely breakfast buffet, I had the front desk call me a taxi and gave them the place I wished to go. I boarded a lovely indian taxi driver’s cab and set out for what would be a rather long, arduous journey. The trip was presented to me in the following manner:


“It should take about 3 hours by taxi. Make sure to follow the signs.”


However, when you look at the website, it says the following:

  • Take the N2 northbound out of Durban towards Stanger
  • Continue along the N2 for approximately 300km past Stanger, Empangeni and Mtubatuba. (Note: there are tolls along this road)
  • Take the turning off the N2 for Hluhluwe. This didn’t look “right” to the taxi driver…so we asked for directions from someone on the side of the road.(see below)
  • At the end of the offramp turn right, following the signs for Sodwana Bay
  • Follow the road through Hluhluwe (past the Engen garage and Wimpy restaurant)
  • At the T-junction turn left  There were no T junctions only roundabouts
  • 1km along this road turn right across a railway line, following the signs for Sodwana Bay
  • Follow this road all the way to Mbazwana (Note: there are nasty speed bumps along this road–be particularly careful of the ones at the turning for Phinda)
  • At Mbazwana there are 2 roundabouts. Go straight on at these roundabouts, following the road around clockwise.  Taxi driver got confused and took the 3rd turn as opposed to the 4th. This took us 40 km down a dirt road until we hit a quarry. We asked directions here again. They had never heard of Mseleni!(see below)
  • 20km along this road there is a green sign for Mseleni. Do not follow this sign, but continue for another 3km until you see a brown sign for Mseleni Hospital. There were at least 3 signs and they were all green!
  • Turn right at this junction and continue to the end of the road, up the hill and through the gate into Mseleni Hospital

Go straight!!! What?

The quarry. 40km in the wrong direction.


I arrived 5 1/2 hours later. Dr. Fredlund, whom I was staying with and was set to meet, was “in theatre.” As I waited for him, I was shown to my room. Long story short, the Fredlund’s had an event and could not house me for the first week and I was put up in one of the lodging houses on the hospital premises. I quickly dropped my bags and headed back up the hill to the hospital where I met Dr. Fredlund. A very kind man, we discussed a few items and he began to walk out the gate of the hospital. He stopped, turned around, and asked if I had plans for dinner. I politely said no and was invited over to his home where I was told we’d be attending a large revival of the AEC(African Evangelical Church) in another town. We packed into a small red car and set off. On the way, I learned how to make that clicking sound common in so many Zulu(the native language here) words. Among other things, I also learned unlike in the states where I am from, here one worries about hitting zebra and giraffes while driving! Yikes. Talk about some damage.


We pulled up and I was quickly shuffled to a small room. Dr. Fredlund began explaining that I’d be eating with the married men. A small schoolroom full of men was what I walked into. After nonchalantly sitting down, i was quickly passed a plate of food. This appeared to be a meat dish with some thick brownish gravy sitting on a bed of thick rice. Everyone prayed by singing a zulu song and the eating commenced. No one spoke and I did my best to shovel the food in. I had some idea that regardless of the taste of this food, it would be rude to leave anything behind. About halfway through the meal, I realized a piece of meat was chewier than I was accustomed to. Yep…that has to be tripe! This was my first time trying this and while I had no issue with the taste, the texture left much to be desired. As I looked up, every other man in the room had finished there plate and was looking at me. I shoveled the remainder of the food in quickly and handed my plate to the woman who served everyone. She grabbed the plate and the room began laughing. As I sheepishly leaned over to Dr. Fredlund to ask if I’d offended anyone, he giggled and said “no.” “They just realized there’s no way you’re married!”

Google image of tripe with samp


The revival is what one would suspect. I didn’t understand any of the service as it was in Zulu, but the music was praise-like and happy. Singing is very important in the worship of the locals. After 2 hours, we loaded the car and headed back. I stumbled to my room and crashed excited for the next days rounds. What would I see? How would my presence be interpreted by the other healthcare personnel? Would the tripe stay down?

The tripe stayed down!

Introducing Myself

July 2nd, 2018 by INMED
Posted in Uncategorized|

Hello! My name is Edward Christiansen. I am a Resident Physician at Research Family Medicine Residency, and I’m starting my INMED service-learning experience at Mseleni Hospital in South Africa beginning in July 2018.