Life in Two Different Worlds

What I have found most striking about living in South Africa is the disparity that exists in almost every element of life.  When you are in the cities you find yourself in the modern world with most of the amenities you could ever want.  But then, not more than a couple miles away, you’ll find a township with few if any paved roads, thousands of tin shacks, garbage piled in the streets, inadequate sewer systems, and little to no electricity.  As you can imagine, bouncing between these two different worlds can make life here frustrating especially since it’s clear that the infrastructure for all of the necessary services exist, but they are poorly maintained and in some cases, not even utilized at all. 

Tin shacks and trash piled up on the outskirts of Ducats

The most gleaming example of a community that has been left behind is Ducats, which is a resettlement area outside of East London.  Being a resettlement area, most of the houses are government-built two-room homes meant to house people that have been moved from over-crowded communities.  Despite the fact that these houses were built within the last 5-7 years, most of them receive no upkeep from the government and as a result, are starting to fall apart.  Many people have erected tin shacks as supplement shelter or to make up for the limited space of these homes, leading the people in this community to revert back to living in the same conditions in that caused them to be “resettled” in the first place.  Compounding the poor structure of these homes is the facts that they were not built with any kind of sewer or water hook ups, forcing the people of this community to use communal taps for their daily water supply and communal latrines for sanitation.  Trash removal is rare, livestock freely roams the community and while there are outlined streets, no formal roads (dirt or paved) exist. 

Probably the most egregious oversight in the planning of this community has to be that there is no clinic.  The nearest clinic is about 5 miles down the road, so definitely not a walkable distance for anyone who is sick.  There are public taxis (minibuses), but that trip will cost an individual $3 each trip, which may not sound like a lot, but trust me, that’s a decent chunk of a person’s daily living expenses in this community.  At one point, Ducats was receiving health services from a mobile clinic, which in itself has its own limitations on the care that can be provided and the number of people that can be reached in a day, that used to come once a month.  This service has recently been suspended due to provincial cuts in the fuel budget for Department of Health vehicles, leaving the community with no local services at all. 

Ducats fieldworkers testing at a community events 

Despite all of these challenges, the community of Ducats is resilient.  They are so active within their community and are hungry for change.  They are constantly holding stakeholder meetings to voice their concerns about service delivery and even take it upon themselves to reach out to departments like social services to come and provide information to the community and host events to spread awareness.  Even the CMMB fieldworkers that were recently hired for the TB project are motivated to make a difference.  Aside from doing an amazing job providing door-to-door testing services, they want to make sure that their new skills can be utilized even after their contract with CMMB ends, and have thus made arrangements with the nearest clinic to continue to provide testing and other health services as volunteers for the clinic.  This is just one of the many reasons why I will always have a spot in my heart for the community of Ducats.

The TB project is taking off!!

CMMB Fieldworker giving HIV test results to a
client in Phakamisa 

While I realize that we are currently halfway through April, this post is going to be dedicated to the month of March, which was absolutely hectic!! As I have said before, the TB project I am working on has really taken off since January.  Each month our fieldworkers are reaching more and more clients with HIV and TB testing services and we couldn’t be more excited! 

Last month was spent trying to keep up with the pace of the project by making sure that as soon as testing was completed in one community, the teams had another area ready and waiting for them.  Aside from the fact that coordinating the movements of 5 teams is a daunting task in general, starting to work in a new area isn’t as simple as pointing to a place on the map and showing up.  Community entry has been one of the most difficult challenges of this project.  It involves working with community leaders as well as other stakeholders to spread the word about CMMB and what services we are providing and, ultimately, getting permission from each community to work in their area. 

Homes in "TB crisis" area of East London

As I am sure you can imagine, each community is vastly different.  They all have their own power structures and politics that play a role in their final decision.  Most communities are simple: we explain what we are providing, they like the fact that we are offering our services, so we start working in their area, no problem.  Other places have created a myriad of hassles causing us to start working, then getting chased away, then asked back because other community members really want our testing services, and then chased away again... leaving you feeling like you are in an endless cycle. 

On top of trying to keep up with all community entry struggles, it was decided that we should try and expand our project to the East London area. 

Homes in "TB crisis" area of East London

Many of the communities surrounding East London are what the department of health deems “TB crisis areas.”  They are densely populated and most have extremely substandard living conditions, which is only contributing to the problem.  I think this is a really great opportunity for the project to have a huge impact in an area that is truly in need of an intervention.  The process of getting everything set up and teams in place to offer door-to-door services is definitely not going to be a picnic but I’m excited for the challenge and to see what will happen over the next couple of months.

I think what I really love about this project is that even though its only been fully operational for 6 months now, we are able to see an impact.  The department of health has seen a dramatic impact on their TB indicators (the factors they use to measure the effectiveness of TB services in a given area) and they are

extremely pleased with our progress.   The communities are grateful as well.  Whenever I get to go out into the field, it is very apparent that most people really just don’t know anything about TB.  They don’t know how you get it, they don’t know how to prevent it and they don’t understand the importance of treating it.  The plus side is that, at least in my experience, many of our clients become extremely engaged in the conversations about TB.  They always have so many questions and by the time they are finished with the testing and education process it seems like they are walking away with a lot more knowledge then they had before.  The project may not be perfect, but at least something is clearly working, and that makes all the stress of work and being far from home totally worth it.

Young clients learning about HIV and TB 

IOU

It's definitely been a while since I had time to post, and in all honesty, I have no time for a legitimate post at the moment.  The project I am working on has been doing extremely well, with the number of clients served growing each month.  Needless to say, its keeping me busy.  In the meantime, I'm just going to share a link to the writeup CMMB did about my project for World TB Day a couple of weeks ago.  I think it's a really great overview and might give a good idea of what I am doing on a daily basis.  Enjoy!  I promise more posts soon!

http://cmmb.org/offers-door-door-tb-testing   

The Past 2 Months

Alright, so I know its been almost 2 months since I last blogged but in my defense it was the holidays and then the beginning of the year was quite hectic and I have barely had a spare moment… with an internet connection… to keep this thing updated.  So I think its best if I just dedicate this post to a semi-brief update for the last two months. 

Christmas Day on top of Table Mountain in Cape Town

Shopping at the Pan-African Market Cape Town

I spent Christmas and New Years in Cape Town with Krista, the other MVP in South Africa, and Winrose, a nurse from Kenya who works for CMMB’s Medical Male Circumcision project in KZN with Krista.  It required a 20-hour bus ride from King Williams Town, but it was totally worth it!  We had a BLAST!  Cape Town is easily one of the most beautiful places I have ever been and we spent our vacation touring around, laying on the beach, and of course, eating lots and lots of seafood.  Highlights included a Christmas Day on top of Table Mountain, Hiking out to Cape Point, seeing penguins, daily time on the beach, and a few days hanging out in Stellenbosch (wine country).  I think the general consensus by the end of the trip was if we had a choice, we would never leave Cape Town. 

South Africa Strategic Planning Meeting Group Shot

So all in all, the holidays were great but I was quickly snapped back into reality when the office opened in January.  The TB project that started in August had really been gaining momentum in December, and when we came back from the holidays we found that our fieldworkers had been working over the break and were ready and raring to go.  The beginning of the year also brought lots of planning for the projects and several meetings with all our partners and the communities we work with to prepare for the needs of the coming year.

TB Nurses ready for testing at Walter Sisulu University

The end of January brought a last minute invite to Pretoria for CMMB South Africa’s yearly strategic planning meeting.  The meeting consisted of the staff from the South African head office, project managers, MVPs, staff from the US offices, and regional directors as well.  The point of this week long meeting was for everyone to come together and make a plan as to what issues need to be addressed in the projects and how will CMMB SA as an organization move forward and develop during the course of the year.  The week was extremely productive and I personally really enjoyed the opportunity to collaborate with staff from different countries, specialties, and projects. 

Training on the new PIMA machine to do CD4 counts in the office 

Despite the fatigue following a week of all-day meeting everyone seemed to leave Pretoria ready and raring to advance our projects throughout the coming year.   As a result, February was insanely busy.  Per usual, the month was filled with community events and trainings.  I am really happy to report that our fieldworkers and nurses have really gone above and beyond this month, providing services to more clients than any other month the project has been running.  Of course reaching and exceeding our targets is impressive, the truly exciting fact is that those “targets” are people who are directly benefiting from the services that CMMB is providing.     

Field Trip

Kid trying to figure out why I am pointing my phone at him

This week I was able to spend some MUCH needed time in the field.  Don’t get me wrong, it’s not that I don’t  loooooovvvveeeee compiling data and writing reports in the office, but I am always happy to have the opportunity to visit the communities where we work.  I think it gives me a much better perspective of how the TB project works.  Sure I can look at the numbers and see how many people are benefitting from our services each month, but going door-to-door lets you see who these people are and how much of an impact providing something as simple as an HIV test or TB screening can have.  

Fieldworker counseling a client in her home

This week I went to Sweetwaters, which is an area just outside of King Williams Town, mainly to observe our fieldworkers in action and help identify/correct any problems they are having with the project.  Let me just say, our fieldworkers work SO HARD.  They are so great at interacting with the clients and you can tell that they really have a passion for what they do. 

Mrs. Ntutu explaining how to followup with clients

One of the best parts about being in the field is that you get to see the people our programs reach.   For me, it’s nice to actually put faces to the numbers that I deal with all day especially when you can see the impact providing door-to-door services provides on an individual level.  Even more awesome is seeing Mrs. Ntutu in action.  She is the project supervisor and she is SO good at her job.  When she is in the field, you can just tell she is totally in her element.  She loves teaching the fieldworkers and interacting with the clients.  She is the person who definitely goes above and beyond the services of our project to make sure that our clients are being linked up with the services they need.  The world could definitely use more people like her.  

World AIDS Day

Bongiwe and Ntando posing with CMMB car

On Saturday, CMMB was invited to be an exhibitor at the Eastern Cape World AIDS Day event in Mdantsane.  There was a huge build-up for the whole month prior to the event to engage the community in health education surrounding HIV/AIDS as well as encouraging them to attend the event.  CMMB took part in this build up during the month of November by going to the taxi ranks in King Williams Town and offering testing services to people coming and going in and out of town as well as promoting the event in Mdantsane.  We also joined with the Department of Health’s door-to-door services (obviously our specialty) and visited homes in the areas surrounding Mdantsane.  During this outreach CMMB did their normal practice of offering counseling and testing for HIV as well as screening and testing for TB.

Ntando setting up his testing station

On World AIDS Day, the event was held in an outdoor stadium where the finals for the youth soccer, netball, and boxing tournaments that had taken place in East London during the previous week were played.  The events also included speeches from keynote speakers and focused on youth outreach to promote their goal of a generation with 0 new cases of HIV.  Unfortunately, the weather was not on our side.  It was cold, rainy, and windy which definitely put a damper on the festivities.  But still, all things considered, the event was pretty well attended.  CMMB had a tent set up and offered HIV counseling and testing as well as general health information pamphlets.  We had to get creative to create private areas for people to test.  Solutions included creating makeshift partitions in the corners as well as using the CMMB car as a testing “room”. 

Timbela counseling a client

Family poses while waiting in line for testing

For me, I rarely get to go to the field so it was fun to watch our fieldworkers interact with clients.  They are all so passionate about what they do and so good when it comes to interacting with clients.  Even though it was a busy day from start to finish, it seemed like everyone on the team really enjoyed themselves.

This might actually be working!!

I just wanted to share a really awesome story that was shared with me yesterday.  Im sure it won't give you all the "warm fuzzies" that it gave me but I am going to share it with you anyway....

I was at a meeting yesterday with the sub district office for SA Department of Health (they have partnered with CMMB for the TB project that just started a few months ago) and the clinic programs manager, Mrs. Nelani, shared a great story with us.  She was at a funeral (this is not the "great" part of the story)this past weekend in Ndevana, and area where CMMB provides testing services, for a man that had died from TB (also not the "great" part I am referring to).  At the funeral they spoke about how sad this death was because it could have been prevented.  Then as more people got up to speak they kept talking about how TB is a disease that needs to be taken seriously and pleading with people in the congregation who are on TB treatment to stick to their regimens.  They also talked about the importance of people being tested for TB and that, as a community, they can prevent this disease etc etc. 

After the funeral Mrs. Nelani was so impressed with the information that these speakers were sharing with the congregation.  She asked one of the speakers how he and everyone else knew so much about TB.  The man told her that he and his community had learned about TB from "some Catholics" that have been coming door-to-door offering HIV and TB testing.  As soon as he said that, Mrs. Nelani knew the "Catholics" he was referring to was actually CMMB.

From my own perspective, I think it is really encouraging to see that the education we are providing to clients is really helping people to understand more about TB as a disease.  Of course the testing services we provide are important, but in all honesty, the health education that accompanies testing is the sustainable piece of this program that is going to last when project is over, hopefully helping to prevent new cases of TB in the future.  And after all, that's why we do what we do.  

Training Day(s)

Field Workers and Nurses learning about HIV Counseling

OK.  So just a little background on CMMB’s TB project before I get into the important part of this post.  CMMB started their TB project, which involves door-to-door screening for TB and HIV testing aiding in the South African Department of Health’s intensified TB case finding campaign, in late August and really had to hit the ground running.  Approval for the project was wrapped up in red tape for quite some time (shocking, I know) so as soon as it was approved there was a lot of ground to make up from the original plan.  Because of this, there was little time to prep our field workers and nurses leaving most of them to have the bulk of their training on the job. 

Mama Gwiji Demonstrating how to collect Sputum

In order to make sure all the teams were on the same page and adequately armed with the information about HIV and TB, a mass 3-day training was held last week for all of our field workers and nurses.  Topics included a review of HIV and TB symptoms and disease processes, counseling methods, HIV testing procedures, specimen collection, etc.   Questions were addressed and solutions for some of the issues being experienced in the field were implemented. 

Overall it was an extremely successful training.  Our Field workers are so motivated and were so enthusiastic about participating in the training sessions.  I think they all left with a much better picture of HIV and TB as well as the impact they can have on their communities through CMMB’s project.  I am really excited to see the progress we make over the next year! 

Happy Thanksgiving!!!!!

Yes, yes I know I am a few days late but since it was just another workday in South Africa, festivities with my host family had to wait until Friday night.  Can I just say, I found it somewhat difficult to properly describe Thanksgiving.  I feel like I must not be doing it justice because most of my coworkers said it sounded a whole lot like Christmas to them.  Even more challenging was describing Black Friday, and now I’m pretty sure they think Americans are crazy.  They might be right… 

Anyway, last night I cooked a small feast and my family and some friends came over to partake in my make-shift holiday.  I of course made everyone join in with the cliché Thanksgiving tradition of going around the table and say what you are thankful for this past year and it was pretty clear that we are one lucky group of people who have been blessed with love, family, and wonderful experiences. 

Turkey Day Spread

I think the success of my Thanksgiving was best summed up by my host mom, Bomza.  This morning she told me,  “Nikki, your Thanksgiving meal was so wonderful last night, but I ate so much I almost died!”

And now just a few things that I am thankful for this year:

I’m thankful for a host family that entertains my requests for celebrating American holidays.

I’m thankful for the friends that I have made in South Africa, I don’t think I would be surviving without them.  

I’m thankful that I have such wonderful friends at home who have made me feel like we are just in different cities not on different continents.

 I’m thankful for my wonderful host family that has made me feel right at home since Day 1.

 I’m thankful for my family back home who has been so supportive and encouraging of this adventure.

 I’m so thankful to have this opportunity and excited to see what will happen during the rest of my time here! 

TB or not TB?

Many of you who know me, especially my fellow MPHers, know that I have a ridiculous obsession with Tuberculosis.  It's truly a fascinating and quite complicated disease posing many issues in the way of both treatment and prevention.  South Africa has one of the highest rates of TB in the world mainly due to its massive population of individuals infected with HIV.  TB treatment and prevention is one of South Africa's Department of Health's top priorities, which is why CMMB has recently started their TB project which consists of going door to door to screen people for the disease.  Naturally I gravitated to this project and I have been trying to use what I learned in my Masters program and what I gained from my experiences working in TB in Kenya to contribute its development

TB Poster in Grey Hospital Clinic KWT

I know finding and treating someone with TB seems simple enough, but its really a quite complex process.  The first round of screening is a questionnaire about TB related symptoms.  If someone appears to have symptoms, then our field workers collect sputum and send it to be tested.  But, of course, that can't be the end of it.  Because TB is difficult to detect, the standard procedure is to collect 2 samples from each patient on 2 separate days, meaning two trips to each person's house for our field workers.  Once this step is complete, the samples are sent to the lab where they are observed under the microscope.  From this the lab gives you a positive result (they saw TB bacteria under the microscope) or a negative result (no TB seen here!).  Simple right? Wrong.  Now there is the issue of using microscopy to diagnose TB.  It really isn't that great of a test.  For one, TB is easy to miss under the microscope not to mention the many issue that can arise with sample quality and contamination issues.

So what do you do if a patient has a negative lab result but suffers from TB symptoms?  Some of the rural clinics in my area say "that's it, nothing more we can do" while others will refer the patient for an xray and doctors visit.  However this happens at another clinic, which adds cost and travel time for patients that have little time or money to spare.  At every turn TB control becomes more and more difficult.

Sign on Exam Room Door Zwelitsha Clinic

Now lets say your patient's test comes back positive.  Great! They have TB so let's start them on treatment, problem solved.  If only it were that simple... First off, to cure TB a person needs to be on treatment for at least 6-9 months.  That's taking a pill every single day for at least 180 days straight.  If you start missing doses then your problems get WAY worse.  Improper TB regimens lead to drug resistance, and let me tell you, drug resistant TB is not something you want to mess with.  You'll have to go back on treatment for much longer and you're going to have to take more drugs than you did before.  Drop the ball again, you are likely to cause further resistance leaving you with very few options for treatment.

Much more than making sure that drugs and doctors are available goes into successful TB treatment and prevention.  You have to think about the barriers patients face when it comes to accessing these services.  Do I have transport to get to the clinic? Can I afford the associated costs? Can I leave work? Am I worried about stigma if someone sees me in the TB section of the clinic? How will I make sure I I have a continuous supply of medication?

The list seems ENDLESS.  My hope is that through this program we can address and eliminate many of these barriers by bringing clinic services directly to the people in our communities and having a well-defined referral system for the services that are beyond the scope of what CMMB can provide.  Establishing this should make for a VERY busy year.

MTA: Beyond Just HIV Testing

This past week, I had the pleasure of meeting with the fieldworkers for CMMB’s Men Taking Action (MTA) Program.  As mentioned in my previous post, MTA aims to increase HIV testing by empowering men with health education to encourage their families to get tested and educate them on how to prevent HIV.  The field workers for this program go door-to-door in the rural areas throughout the Eastern Cape offering HIV testing and counseling along with other general health screenings for tuberculosis, STIs, and diabetes.

MTA Field Workers in fromt of CMMB's KWT Office

Can I just say, our field workers are AMAZING!  The program has been running for 4 years and they still approach each day with such enthusiasm and with a commitment to furthering the project.  They are so organized and methodical about making sure they offer services to all the homes in their respective areas. 

What I really love about this project is all the benefits that come with offering HIV testing services in the home.  For one, clinics in these areas are few and far between making it difficult for families to access care.  Furthermore, the stigma surrounding HIV is high and because of this, many choose to not get tested because they don’t want to be seen going into the clinic for any HIV related service.  By giving them the option to test in the privacy of their home it actually increases their likelihood of getting themselves and their families tested.  

Field Worker's Map of the Houses Covered in his Area

Not only does CMMB provide services directly to the client, but also through the course of the MTA program, our field workers have served as a link between our clients and the services they need.  In our meeting last week, one of the field workers Xoliswa, was telling us about a family the she encountered on her daily rounds in Ndevana.  The head of the household was a young woman who had been left to care for her 1 year-old son, 4 of her brothers and sisters, and her grandmother.  The woman was HIV positive but was unable to get her supply of ARVs, her child was ill, and the whole family was suffering from malnutrition.  Seeing the state of the house and family, Xoliswa made appointment for the woman and her son at the clinic for the following day.  There, she was able to get a supply or ARVs, her son was checked out and treated, and the woman met with a social worker to apply social grants to help take care of her family.  

About a month later Xoliswa stopped in to see how the family was doing and was pleased to find them in a much happier and healthier household.  To me, this is just another great example of how willing the field workers are to go above and beyond to make sure that their clients are linked to services beyond the scope of our programs.    

Bizarre Foods!

Ok so the foods I've had this past week are not really bizarre but they are definitely not what I would consider my "normal" or "everyday" types of food.  So I don't think I have told you much about my host mom but she has a side business as a caterer.  Needless to say, I have yet to have a bad meal.  She has been trying to cook things that she thinks are American or something I will recognize but last week I told her that I would love to try some traditional Xhosa dishes.  Man, I definitely got what I asked for!  So far this week dinner has included cow liver, sheep tripe, tongue, and chicken livers.  Like I said before, my host mom is an amazing cook but man, I don't think I am meant to eat liver, from any animal or in any form. The tripe and the tongue, on the other hand, were pretty good!  In addition to new and interesting meats we also had samp (kind of like corn meal) and peas, Umbhako (steam bread), and dumpling bread.  There are talks of a pickled fish dish for next week, I'll keep you posted...

The Work We Do

The view heading out of town

I realized that I totally forgot to talk about what I doing work wise, you know, the whole reason why I am here...

I am based in a CMMB office in King Williams Town that is running 2 really cool projects.  The first one is called Men Taking Action (MTA) which is in its 5th year!  Basically, CMMB targets men in the rural communities with education surrounding HIV and urges them to discuss HIV with their families and for all of them to know their status.  To accomplish this, field workers go door-to-door in the rural areas and offer free HIV testing and counseling.  This method of HIV screening gives people the privacy to test in their own home (ideally making it more likely for them to find out their status).  Clients receive their results in 15 mins and if they end up testing positive they are referred to treatment centers so that they can have confirmatory tests and if needed, start on meds and receive education on how to properly manage their disease.  As this project has progressed it has also encompassed additional health screenings.  Now, the field workers will screen people for diabetes, STIs, and hypertension all at home to help reduce the burden of getting to and from the local clinics which can be pretty far from where many of these people live.

Buffalo River running through Amatole

The new project that just started a little over a month ago is a Tuberculosis program modeled after MTA.  It follows the same premise, but it focuses on TB screening and sputum testing services.  There have been a few kinks to work out which has made for some hectic days at the office but all in all the program is off to an amazing start and I'm really excited to see how things progress over the next year!

In closing, I FINALLY got to go out to one of the rural areas today, albeit just to quickly drop something off, so the pictures above are of the scenery we passed while driving out to the clinic.  Oh and dont worry, I have been promised many more longer trips out to where all the action happens, so more amazing photos to come! 

Houses on the hills of Ndevana

I made it!

Ok so yes, I have actually been here for 2 weeks now but I kept putting off blogging because I didn't know what all to say.  Alright, lets start with the basics...

I arrived in Joburg on the evening of the Sept 25 and then took a train to Pretoria, and let me tell you, I looked SO ridiculous dragging my 2 giant bags and backpack on and off the train in my post flight zombie-like state.  The next morning I went to CMMB's head office for a quick orientation and overview of all their programs then was whisked back to the airport in Joburg (the second go at the train with all my stuff was much better than the first) were I caught a flight to East London.  When I arrived in East London I was met by my new host mom and my project manager who then drove me to King William's Town.

Let me tell you about my host family.  They are AMAZING. I have a host mom and two sisters and all of them are hilarious and so loving.  They had my room all made up and decorated for me and had a delicious dinner waiting for me when I got there.  So far things are going great at the homefront.  Every day when I come home from work, we start dinner and pretty much just hang out until its time to go to bed.  On the weekends we are always going somewhere or doing something so all in all, life is good!

Bring and Braai Fundraiser

Let me start off by saying I have AMAZING friends.  Seriously, they are absolutely, totally, one hundred and ten percent the best and Mercy, I could not have pulled this off without you!!!

So the fundraiser for CMMB which was supposed to double as a goodbye party for all of us leaving NOLA was originally scheduled for August 28th.  The plans had been made and the food had been prepped and then, along came Isaac.  As sad as I was to have the event canceled I truly cannot  think of a better way to end my time in New Orleans than by riding out a hurricane.




Long story short, the fundraiser was rescheduled to last night and even though I wasn't in New Orleans anymore, my friends held it for me.  All things considered it was a pretty great turn out.  It was held at Handsome Willy's Bar which is right across the street from Tulane School of Public Health and a favorite hang out spot after class.


It was a great night to sit out on the patio with delicious food (South African BBQ style), great drinks, and live music.  I heard that a Painter even showed up at one point!   It sounds like everyone had a great time.  Thanks so much to everyone that made this possible, I miss you all!!

It's Officially Official!

My ticket has been booked and I will be leaving for South Africa on September 24th.  Now I just need to figure out how to entertain myself for the 19 hour flight... suggestions welcomed!

And thus it begins...

The countdown begins!  I will be leaving for South Africa in late September and I have to admit I am a combination of excited, anxious, nervous, sad, worried, and elated.  More details to come!  I wish I knew what to pack...