Unlike fistula (which have also been discussed at length this week, due to the UNFPA petition), cancer is not a disease largely limited to the developing world. Access to screening is a challenge for American citizens (thanks newly in part to the task force’s ludicrous new recommendations about mammography) just as it is for South African citizens. One major difference is the attitudes toward cancer; in the United States and Europe, nonprofits, NGOs, activists, and survivors have worked hard to make cancer an acceptable topic of public conversation; one might argue that their leadership has given way to new technologies and medical options.

In Africa, Eastern Europe, and many Asian countries, stigma around cancer is still largely a barrier to care. In countries with raging HIV epidemics, a bald, thin cancer patient is likely to be mistaken for an AIDS patient. In patriarchal societies, women do not have the option to elect to have a mastectomy because in that culture, their breasts belong to their husbands, not to them. Across the board, many people believe that cancer is a death sentence; as 75% of people in developing countries present to the doctor when their tumors are already at Stages III and IV (meaning that the cancer has spread beyond the original site, and therefore is much harder to cure), it is no surprise that this belief prevails.

In a session on cancer yesterday (one of just a couple at the entire conference), an OB/GYN graduate of Brown University’s medical school stated that we cannot think of the standard of care in North America and Western Europe as the standard of care worldwide. Where doctors might recommend regular mammographies starting at a certain age stateside, that technology is not widely available, and to put forth that recommendation when women cannot then access the services is irresponsible. Medical professionals have looked into self-exams as a cheap and empowering alternative to mammorgraphies in resource-limited settings- but without significant results. As I listed to all of this, I couldn’t help but think about Janet, a young pregnant Tanzanian woman from Christy Turlington’s film, No Woman No Cry, who very nearly tried to give birth at home because the idea of walking 5 miles to the nearest clinic (very small, basic services only) was unbearable. I cannot imagine that should Janet do the self-exam and discover something abnormal, she would make that trek to a clinic where she would likely be referred to the overwhelmed Mount Meru hospital at a significant cost to her family, to discover that her options for addressing this “abnormality” are limited, at best, and prohibitively expensive.

So, what needs to happen? From the medical side, find a way to bring clinical trials to even rural areas; there are hardly any clinical trials in developing countries, even though such trials might offer opportunities for treatment that might not otherwise be available. Additionally, we need to encourage countries to develop their own best practices in community outreach, stigma reduction, and medical opportunities. Link contraceptive care with cancer care; as part of the continuum of health care in a woman’s life, the two are connected, and one can most certainly influence the other. And lastly, to return to the refrain of Women DELIVER: Empower women and men with information. As Dr. Frenk said yesterday, “Include men in the solution. If you exclude them from the solution, they will continue to be part of the problem.”

To learn what JSI is doing around cancer & stigma abroad, read about the LIVESTRONG-JSI Anti-Stigma Cancer Campaign in South Africa and the Survive & Sustain projects in The Republic of Georgia.

Of course, these conferences are mainly attended by individuals who already know the answers to the key questions and are, to the best of their ability, trying to apply modern best practices to complicated health situations. High profile speakers are called in to reiterate what we already know, and by the time we board the plane home laden with conference booklets, reports, and shwag from the expo booths, the energy generated through the conference camaraderie is insufficient to tackle that to-do list:

• Bring governments on board to commit resources to maternal health programs, monitoring & evaluation
• Strengthen health systems to better provide opportunities for women and girls
• Improve integration by building public-private and cross-sector partnerships
• Increase use of technology to help address issues of medical human resources deficits
• Mitigate cultural and religious barriers that prevent women from accessing the education and healthcare they need in order to change their situation

Errrr, yeah. I’ll get right on that…

That said, Women DELIVER may actually turn my previous stalemate experience on its head. For one, this conference already has an action plan. The cadre of strong women leaders who spoke yesterday are already backing up their inspiring words and speeches with actions. Arianna Huffington has opened her well-known online paper to continue the conversation from a surprisingly stellar Women Empowerment panel and keep the issue in the press. Christy Turlington Burns aired her film, No Woman, No Cry last night; more importantly, perhaps, she recently showed the film to 5 sold-out audiences at the Tribeca Film festival–audiences who probably attended for her celebrity, but came out learning about the global impact of maternal mortality. Christiane Amanpour and Ashley Judd are using their positions as a well-respected journalist and actress/activist to bring attention to maternal health on the global stage. Most notably, Melinda Gates announced yesterday that the Gates Foundation is giving $1.5 BILLION in grants for maternal health projects. For a full overview of key messages and summaries, visit the Ms. Magazine blog, K4Health’s summary of the first day–including a link to Women DELIVER’s action plan, or Women DELIVER’s own live blog of the conference.

As Director General of the World Health Organization, Margaret Chan, suggested yesterday, “Let’s walk the talk, and deliver a health system that supports our women.” I’m excited to see what kind of walking (or hopefully running) comes out of the next few days.

Now, several years later, as I dabble in HIT and social media, I realize that my interest in the intersection of technology and healthcare was set in place as an eleven-year-old osteosarcoma patient, when I agreed to pilot test a system called Starbright. A precursor to what is now Second Life, Starbright was meant for kids, who spent their days in hospitals, isolated from friends. Together with my chemo buddies, I spent hours playing on Starbright, making recommendations to the developers about how to make it “even cooler.” I met a girl named Vanessa from California, who had the exact same kind of cancer in the same arm as I did; in a year of treatment and surgery at a major New York City hospital, I had yet to encounter anyone else who had bone cancer, let alone in her dominant arm. Just a few short months later, I was seated next to Steven Spielberg and across from General Norman Schwarzkopf, helping them show off what Starbright could do for kids like Vanessa and me. I remember that day so clearly, partially because it was the first time in a year that I had gone outside in public, bald. Yet, it was the experience of meeting Vanessa and working on Starbright that I subconsciously retained. I don’t think that it is a coincidence that part of my job at JSI is advising on new media strategy. I think the groundwork for my social media interests was laid in place back in 1995, when I was figuring out how to use my right arm to move a mouse along a mousepad to explore a cave in a virtual world with my buddy in California.

A similar coincidence takes me back to the summer between sophomore and junior year at Brown. I stayed in Providence for the summer, interning for free at a start-up nonprofit. Always concerned that I not waste my time, my mother insisted that I take a course at Brown to “keep my brain sharp,” so I chose “Doctor-Patient Communication,” a public health course that sounded interesting-slash-relevant. As part of the course, we were asked to shadow a doctor at a nearby hospital on a weekly basis and write a research-based report as a final project. As it goes, the doctor I followed was one of the early doctors to use a computer in the exam room as a means of tracking health information. Having spent a significant fraction of my own life repeating my medical history to doctors, nurses, interns, residents, radiologists, anesthesiologists (I can keep going…), I thought it was brilliant. My study (and I’ll admit, it was incredibly rudimentary), gauged patients’ level of comfort with the computer in the exam room and whether they felt that it impeded on their relationship with their doctor. Having spent a few days learning about monitoring & evaluation at work, I cringe at the study itself, but once again, I’m thrilled that this seemingly isolated experience has come back to resurface in my work. Now, I’m utterly immersed in HIT, HITECH, and their implications fore revolutionizing the health care system (I could wax philosophical about that for hours), but it’s an interest that I discovered long before it was relevant to my work.

I’ll close with two quotations, both of which I return to during the more contemplative periods in my life.

“If there was some dial I could turn to fine tune the fuzziness of life, I’d tell you where to find it. But I don’t have a clue. And I’m not sure I’d want to know. There’s some magic in the way we remain mysteries to ourselves.” -JL

“I wanted a perfect ending. Now, I’ve learned, the hard way, that some poems don’t rhyme, some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment, and making the best of it, without knowing what’s going to happen next. Delicious ambiguity.” – G.R.

I am going to bed deeply disappointed about the outcome of the Massachusetts special election, but I go with fresh perspective courtesy of a few friends:

-The loss of Teddy Kennedy’s seat is not a sign that people do not want access to quality health care; rather, it a sign that this bill, as it stands, does not have the backbone it needs to address the myriad of problems in the US health care system.

- “Health reform” is not an effective slogan; it wasn’t in the 90s when Hillary Clinton was championing her approach, either. In 2008, President Obama infused the very abstract word “change” with new, more concrete meaning, yet “health reform” retains all of the negative connotations and abstruse implications that killed similar efforts for change over a decade ago. We need to drop “health reform” from our vocabulary; for as long as the process is too complicated to explain, as long as the jargon and technicalities stray far from the actual requests of the American people and those who care for them, real change will never come to pass. Mr. President, you’re an orator, an expert in reframing the dialogue; let’s take this “blow” and use it as an opportunity to repackage this convoluted black hole of a bill into something more accessible and transparent.

Finally, a great piece from Health Affairs from last week on the value of integrated care systems in this process.

We headed off down the coast toward Cape Point, which had been advertised to us as the southern most tip of Africa. Turns out, it’s the southwestern most tip. We drove along the water on our way down the coast, passing by beaches and homes that represented a lifestyle I cannot begin to fathom. For those views, I would settle in a thatched hut. (See last photo).

We stopped over in Simonstown, the naval port of South Africa. I saw a few sailors out and about and thought of navy bases back in the states. Not quite the same. We had a delicious lunch by the water, with more of the succulent calamari. It literally melts in my mouth and has a pleasant flavor, in comparison to the rubbery kind from home.

From Simonstown, we ventured to the penguin sanctuary, where the jackass penguins (named for their donkey-like sounds) were lounging on the beach. It was unquestionably the closest i have ever been to a penguin in it’s natural habitat.

Speaking of natural habitats- on our drive to cape point, we passed by a sign that read “Beware. Do not feed the babboons. They are dangerous animals.” I figured this to be akin to a “deer crossing” sign and figured I probably wouldn’t actually see babboons. Turns out, they weren’t kidding. We rounded the corner to discover an entire family/pack of babboons holding up traffic in search of food. One had climbed on top of a car belonging to some unsuspecting tourists who had climbed out to take pictures and was basically holding the car hostage. We pulled over and got out for photos, too. It was wild- they were literally running around at my feet. Our driver grew nervous and asked us to carefully return to the van (by carefully, he meant sans babboons.)

At the risk of sounding longwinded (hah) I’ll cut right to cape point. Holy moly, batman. Words don’t describe. I faced my fear of heights (again) and took the longer route from the lighthouse to the very tip of Cape Point (the sign on this route warns: dangerous route 1.5 hours. I would amend it to say 15 minutes and not good for small children or people in wheelchairs.) totally worth it.

I’m now at the airport waiting for my flight and enjoying one last glass of wine. Right about now, my roommates are finishing the pan mass and are boarding a ferry back to Boston. I cannot wait to see them at the airport tomorrow afternoon and hear all about the ride.

At the South(west)ern Most Point in Africa

Cape Point - Cape of Good Hope

Babboons Holding up Traffic!

This babboon literally crossed my feet

For those of us tourists who didn’t have the spatial nostalgia, the museum is a powerful, personal insight into a trying time in south African history. What is yet unclear to Michelle and me, as we later noted, is how the city is approaching reintegration. The process is apparently underway, but is not very successful yet. A talk with the manager of the museum’s cafe shed some insight on potential reasons, which turned into a fascinating social commentary/diatribe. Have I mentioned that I have loved listening to everyone’s stories this week?

The afternoon was spent bargaining at the green market. I am admittedly awful at it. I am able to negotiate down a bit on prices, but I get to a point when I realize that it’s probably 6 dollars for me, but these sales are a primary source of income for the women. I have a weird guilt complex in the bartering process.

A light tapas dinner of vegetables, cheese, and fish and a glass of wine were welcome after a long day of walking. I joined Philip and David for their dinner after, though just nibbled on some calamari myself and was treated to another fascinating international development storyfest. I’m getting spoiled.

Tomorrow I check out, then Michelle and I head for cape point for one last adventure before I depart.

I jumped at the chance to go on a bouquet mission this morning to the flower market around the corner. Though it was pouring out, Michele and I borrowed umbrellas from the hotel and headed for the markets. I spent the rest of the morning making 140 flash drives for our grantees, then taking 200 photos of grantees receiving certificates, using my phone bc my camera battery died, unbeknownst to me. I definitely do not think like a photographer yet. I check my laptop battery and my phone, but having used disposable cameras on the rare occasions when I wanted to take pictures, charging camera batteries isn’t a priority yet.

Because we weren’t involved in the logistics, Michele and I were basically done early, so we ducked out to go to robben island. On the boat, we ran into a number of other grantees who were also escaping the claustropobic feeling at the hotel. It felt so good to be on open water again. The tour at the island was quite powerful. Lead by one of the former prisoners, who let me record his stories ( so different from us museums), the tour was pretty impressive. I thought we were a bit shuffled around in large groups more than I would prefer, but it’s something I’ll never forget.

We walked around the stores at the waterfront on the hunt for FIFA jerseys, and even ventured into a woolworths (in capetown, it has a supermarket much like whole foods- eg i enjoyed a turkish rose flavored yogurt for a snack). Though we toyed with staying on the waterfront, we returned to the hotel area for dinner. A few of us ventured into malaysian muslim part of town for cape malay food. Still on my veggie kick, I had a delightful lentil kalai curry. Being veggie in capetown has some perqs- dinner worked out to about R80 ($10).

All in all, a pretty great day. Looking forward to more outside time tomorrow and Sunday before another 24 hour trip home.

On a random note, my roommates in Boston start the PMC this weekend. Join me in thinking good thoughts for them!

Tuesday night, the technical providers went out for a wine tasting. I wasn’t drinking or eating yet, so I was enjoying only the scent and color part of the tasting. Admittedly, I was concerned for a bit that I had lost my palatte (everything smelled like dirty socks to me), but my dining mates determined that the wine selection was sub-par. We more than made up for it Wednesday night; we enjoyed a delightful tasting menu at Jardem, home to the 2008 best chef in South Africa. Eager for real food, I embraced my new eating pattern with a first course of mussels, steamed in a paper bag with lemongrass, coconut milk, and ginger. Second course was a potato gnocchi with greens. I finished with a delectable cheese plate, which made me think of wine and cheese dates from my new york days with my friend, Meghan. I find that there are so many parts of south Africa that I want to share and enjoy with friends from the US.

There has been much more to this trip than eating/drinking or not. I have completed 7 of 8 interviews/trainings. It has been such a learning experience for me (probably more so for me than for our grantees). I have positioned myself as a communications resource for them, and I hope in the two years remaining in this project that I have an opportunity to see some of these projects on the ground. I will return to the states on Sunday, eager to learn more about communications strategy for development, particularly demonstrating impact (not just outreach).

On that note, I had a delightful breakfast with a norweigian woman named Ingunn (she recognized my inner swede immediately!), who is working in vietnam right now. We were joined by another grantee, who is from Mexico, and one of our TWG reps (a fellow foodie, and the mastermind behind last evening’s gourmet feast.) our topic was measuring anc documenting impact, which stemmed from many discussions I have had with the grantees this week. It is a question I struggle to answer in my Web2.0 work; we raise all this awareness, yes, but have we really made a difference? If so, how can we measure it, and how can we document it? I still don’t have an answer.

I woke yesterday morning after a semi restless night with childlike curiosity about all that the daylight promised. I scampered (yes, scampered) to the window and threw open the shutters to take in the view… And wow. Where there was nothing but pitch black space just 2 hours before, Table Mountain was standing large and much closer than I had imagined. It reminded me of my first sight of McKinley in Alaska 13 years ago. Who would have thought that darkness and clouds could make such monstrous and beautiful mountains completely disappear?

Around 930, I made my way down to the lobby to a working breakfast with my JSI colleagues. Though I will play a very minimal role in the technical training and action planning part of this week, it was so helpful for me to be included in the planning session. I have a newfound respect for the senior advisors and international project coordinators at JSI, but moreover, I have a better sense of how I can work with the grantees to help target their communications around these technical areas.

I know I have been quite vague about my role here. Some more information: the New Partners Initiative is a PEPFAR experiment supported by AID, CDC, and HRSA to expand the number of local partners in PEPFAR countries to address the HIV epidemic. Rather than throwing large sums of money at these new grantees, USG has hired two technical assistance provider firms ( JSI and AED) to provide all kinds of administrative support. I am here as a communications specialist to help one group of the grantees better utilize tools to connect with partners and donors. The help I provide depends on the grantees’ needs and initiatives. I’m definitely excited.

Following another meeting with our technical advisor cohort, several of us decoded to take a walk. We originally hoped to go up Table Mountain, but we learned that the cablecar to the top is closed this week, so we settled for an uphill walk to the base of the mountain. Two hours later, and several San fraciscan-like hills later, we veered off the road and climbed up to a ledge to the right of the mountain. With the mountains above us and a great spanse of waterfront below, we sat for a brief respite, then took note of the cries of our rumbling stomachs and headed back down toward the waterfront for lunch.

As we decended, we walked along a narrow path lined with barbed wire fences. The fences were protecting houses with such cool, mod architecture. My roommate would have loved it. It was starkly different than the scenes we saw on the way up, when we had several subtle reminders of the poverty in south Africa ( it can be easy to overlook when you are staying on the 27th floor of a glitzy hotel next to a woolworths.)

It turns out the waterfront was further than it appeared from our ledge. After another hour of walking, we gave up on our intentions to be healthy and hopped in a cab to the waterfront, where we treated outselves to oysters, seafood plates, and white wine. Once again, I thought back to Alaska, where my initial affair with seafood began. I was told then that i might never taste seafood quite as fresh, but I think it’s fair to say after yesterday’s lunch that Capetown gives Seward a run for it’s money.

I had another meeting early in the evening to map out my communications plan for the week. I retired to my room for a while, where I fruitlessly attempted to connect to the interweb, but after an hour of wishing ill to the laptop, I decided to take a power nap, as I was basically running on fumes.

An invitation to savor another glass of wine in the hotel bar with a current and former colleague easily lured me from my insta-slumber. Downstairs, I was treated to a host of stories about life in international development. I felt a bit embarrassed that prior to this trip, my international experiences were limited to the more mainstream European countries. I didnot have much to add to a conversation about international schools in India and guatemala, but it was fun to listen. As more people joined us, the stories of hippos, crocodiles, and cape buffalo rolled out. I cannot do any of them justice in this format, but I will leave you with this take home message: do not go kayaking on a crocodile infested river in Zambia with a stranger at dusk.

I conveniently bumped into my colleagues en route to the gate and enjoyed another cappuccino with them before going through security for the next flight. I was asked to step aside and immediately began reaching for the 7 million medical documents I have on me, assuming that was the issue. Much to my surprise, I was bumped up to business class – a first for me! It was a delightful flying experience, and it made the twelve hour trip infinitely more bearable.

We were met at the airport by Raymond, our driver, who gave us a “tour” of the city. His tour was more pointing out where fun landmarks would be if it were daylight. Raymond has lived here for his whole life, and clearly his time here has given him unique night sight in this city.

Checking into the hotel was a bit of a mishmash. Lots of details, mental conversions from Rand to dollars, etc. Despite my best attempts to get a room on the same floor as my colleagues, Michele and Kumkum, I wound up four floors down on my own. I started the process of unpacking after skyping my parents to tell them I had landed. As I opened a drawer to the dresser, I saw bugs scatter. And by bugs, I mean roaches. I immediately called the front desk and requested a new room. The new room is 11 floors up and apparently has a mountain view ( I trust I will see that in daylight too.) I have unpacked by sorting my clothes between the various bags I have. Maybe I’m being overly paranoid, but if my mom has taught me nothing, it’s that it is a costly venture to get rid of roaches once you bring them home. Though I have seen nothing yet in the new room, this is one lesson I don’t want to learn the hard way.

I am kicking myself for not bringing my mac here. We paid for a weeks worth of wireless connection at checkin. My phone connected immediately, but I am still unable to get my trusty JSI Dell to recognize the wireless connection. This will make Internet connectivity with group wise tricky this week. Again, I will try again in daylight.

Though I love travelling for work, I find big hotel rooms lonely. In an effort to make the room seem less quiet and big, I leave lights and tv on. I am eager for tomorrow and for the sota to begin. I trust that later in the week, I will be busy enough and ultimately tired enough to fall asleep.