Hi everyone!

It's been an exciting week here. Classes are in full swing, I did my first day of work at the Midwife Obstetric Unit (MOU) in Gugulethu, and I had drinks with members of my favorite South African band!

I'm very happy with my courses this semester. They are my last three! Introduction to Health Systems Research and Evaluation (yes I am in the health systems track and taking the intro course in my last semester...darn scheduling!), Qualitative Research Methods, and Theory and Application of Economic Evaluation. In plain terms, the first two course are a lot about methodology, so formulating research questions, research protocol design, and critical appraisal of articles. Economic Evaluation coincides nicely with the study I am working on. So far we have looked at costing and cost effectiveness analysis, and our study examines the cost effectiveness of various interventions of a PMTCT (prevention of mother to child transmission of HIV. Some folks are saying EMTCT now, for "the elimination of...," because taking ARVs during pregnancy along with other interventions reduces the risk of transmission to a child to almost nothing) program at a pre natal clinic in Gugulethu, a township nearby Cape Town.

Thursday was my first trip into Gugulethu (pronounced "goo-goo-lay-too"). Landon was kind enough to drive us and a medical student visiting from the States, Tori, came with us as well. I went in with an open mind, preparing for the worst after seeing pictures and film of townships lined with tiny shacks for living space. Sticking to the main roads, at least, Gugulethu (or "Gugs") was not exactly what I expected. For example, there is a mall there! I'm not sure if it is meant for residents or tourists. Most folks living in Gugs, to my knowledge, are employed on low income or not employed at all. The MOU and other health centres on the complex, are publicly funded and patients do not pay for care.

The MOU was both better and worse than I thought it would be! Worse only in the sense that there are SO many people waiting to be seen, and even when you hear about those things over and over, it is still different to see it with your own eyes. The most mindblowing line  for me was the wait for the pharmacy...rows and rows of benches just to get medicine! Can you imagine? Most of us get annoyed when one or two people are in front of us at Rite Aid. Can you imagine waiting hours? Sure, folks could also go to a private pharmacy, but that is far too expensive for most living in Gugs.

I found the staff at the MOU to be great, though, which was a pleasant surprise. In the MPH you hear tons of stories about apathetic healthcare staff, which I don't doubt are true. When you are seeing a bazillion patients a day, you are bound to get tired. But, speaking to the staff, it was clear that they were sensitive to patients' situations and needs. I kept thinking of my time at Planned Parenthood. And the fact that a positive HIV test was quite a rare thing for us...imagine the exhaustion of telling every second or third woman you see that she is HIV positive.

In any case, it was an amazing day for me. I'm sorta obsessed with operations (i.e. how a health centre is run) so observing and speaking to staff was absolutely fascinating. The next step of our study is to do a time study in order to measure the amount of time a woman spends at each chunk of her visit. This will help us calculate staff salaries and lost wages for patients per visit.

This is getting long, so I will just very quickly say--I had drinks with Zolani and Kyla from Freshlyground! A friend of a friend visiting from the States traveled with the band for some time and is very close friends with them. I totally blew it an was too embarrassed to say I was a big fan when I met them, but it was still pretty cool to hang out with them! In case you don't know their music, this is my current obsession by them: http://www.youtube.com/watch?v=k-5GzjsxGU0 it sounds one million times more beautiful live. I had the privilege of seeing them perform for the third time last weekend.

Okay, time to go DRIVE myself to the gym....that's right, I have graduated from driving lessons with an excellent instructor who helped build my driving confidence! Took my first solo drive in T's car on Sunday and it was a natural high! Still a little nervous to try again today, but practice makes perfect!

Love!
Kristen