September was a busy month! It started off with a visit from Carrie Kovarik, my mentor from UPenn. She is the one who founded the dermatology program in Botswana and created the resident international grant opportunity for residents. But she hasn’t actually been to Gaborone in 5 years so it was an exciting opportunity for her to see first hand all the positive changes that have been happening since I have been there full time. She was only in Gabs for 2 days so it was a very busy 2 days! Lots of meetings, teaching, clinic, dermpath and then I hosted a braai for her local informatics team.

The main purpose of her trip was to join us a the Global Evidence Cochrane conference in Cape Town. Our group presented two posters on informatics projects in Botswana. I picked this conference because it was in Cape Town (best location ever) and it was a good opportunity to attend an international conference that covered a variety of global health topics.

 

We stayed at the Westin Cape Town which was awesome and, of course, convenient because it is attached to the Cape Town International Conference Center. We booked with our starwood points and they upgraded us to a business suite which meant a corner room with beautiful wrap around views (and a random office printer work station)! My favorite part of the hotel was the breakfast room on the top floor. The room had floor to ceiling windows on all side giving sweeping views of table mountain and the whole city – plus bottomless mimosas and sushi in the breakfast buffet!

I really enjoyed the Cochrane conference. I have only been to one other global health conference because most of my time has been spent just attending derm conferences which can be so overwhelming. Soo much clinical info being crammed into your head that it gives you a headache! Some of my favorite topics covered at the Summit included a discussion of the ebola epidemic and what went wrong/what needs to be done if something similar happens in the future. Also lots of discussion of Syria and the effects of the refugee crisis on health/welfare of locals and refugees in surrounding countries.

The conference was also awesome because I got to meet up with Bob Dellavalle, one of my previous attendings at University of Colorado. We had an amazing dinner at La Colombe in Constantia with Bob, his wife, one of the current derm residents and her husband. Although we had been to La Colombe before, this visit was the best one yet because of some fun new things they had added to the dining experience. Namely what they call the “enchanted forest course” where you leave your table and go into a room that is set up to make you feel like you have crossed over into alice and wonderland. The mad hatter greets you and offers you a chance to try your first dish with edible spoons that are hanging down from a tree branch! They also added a surprise “dessert quiz” where you have to try to identify the flavors of different dishes from salty, sweet, sour, bitter and umami. I failed!

We also got to do a few things in Cape Town that had still been on our to-do list – including a sunrise Lion’s Head hike, touring around Constantia’s vinyards, visiting Kirstenbosch Botanical Gardens and eating at the Potluck Club! As usual we got a little rowdy at our wine tastings and had a pretty memorable late afternoon visit to the botanical gardens where I chased around some geese and rolled around in the lush green grass!

After the conference we headed down to Hermanus. This was literally our fourth attempt to whale watch and go cage diving. And we finally succeeded at both! However it was not exactly the experience we had envisioned. Garrett did a lot of research to try to pick the best company to dive with. He found the only one in Gansbaai that puts smaller groups in the water. Most companies use cages that take 10-15 people at a time. Shark Lady Diving takes out a smaller boat and only puts 4-6 people in the water at a time. We assumed this would be a better experience but it basically just meant that the boat was tiny and the cage that goes in the water was super tiny.

The communication and organizational skills of this company were horrible. It was the tail end of winter when we dove (which is the best time to shark dive) so the water is always cold. However, we had a particularly cold, windy and rainy day. The typical way these dive trips work is that the boat is divided up into two groups then each group goes in the water for about 15 minutes then you switch. This is done 2-3 times. While you are in the water you get the chance to see the sharks swimming and coming at you – but the visibility is pretty poor so it is hard to see them unless they are right on top of you. The viewing is actually better when you are out of the water looking down from the boat.

Our guide decided to have only the first group suit up when we got out on the water, then they got in and immediately the sharks showed up. We were then told to start suiting up – which took about 15 minutes. We were so busy changing that we only got to watch the sharks from above for about 10 minutes. Then we got in the water. For some reason the sharks dissipated and we sat in 40 degree water for 30 minutes without seeing a single shark! This was pure torture. I had to use all my mental energy to hold out and stay in that freezing water. I had to keep faith that a shark would come and make this torture worth it! We had tried soo hard to get to this point of even getting to cage dive so we couldn’t give up!

Thank god we finally got a shark. I was at the edge of the cage next to where the bait was being thrown out so I got the best views. One of the sharks actually bit my corner of the cage and I got my hand smacked by his tail as he swam away!!

It is insane how innocuous the great white can look when they are just swimming. They just look like any other shark. But then when they open their mouth to attack – that is when you see their true colors. They are incredible beasts. There is nothing like seeing those jaws open up and lunge for a kill. We saw some great breaches and saw 6 different great whites total. The largest was about 10 feet. One of the female sharks had a bent pectoral fin – we were told it was likely from overly aggressive mating.

Over the past few months there has been some strange occurrences in Waker Bay and the Cape peninsula. A pair of male Orcas have come into the area and been attacking great whites. You wouldn’t think an Orca could take on a great white – but they absolutely can. Orcas are incredibly smart and fast. They surprise the great white and usually give them a strong head butt, this stuns the shark and can flip him on his back. When great whites are on their backs they are completely immobilized and defenseless. The Orcas then come at the abdomen and rip out the liver in one bite. That is all they take, then they leave the shark to die. Dead great whites have been washing up on the beaches with missing livers for a few months. These events have actually scared all the great whites out of the area – so we were lucky to even see any. In just the week before we visited, some sharks had finally started to return to the area because there had been no Orca attacks for a few weeks. No one knows why these Orcas have come to the area or why they are so vicious but it is really damaging to the local shark population.

After finishing our time in the cage, we got out of the water, and our guides insisted we take off our wet suits. But they would not allow me to get my bag to get clothes to change into or even a jacket. I was only given a tiny towel and ordered to sit because the boat started jetting back to shore. At that point my hands and feet were purple and numb – I was really afraid that I was getting hypothermia. You can actually lose fingers and toes from something like this. It isn’t something to take lightly. The guide wouldn’t stop or provide any assistance. I sat miserably shaking for the 15 minute boat ride back. Luckily the feeling in my fingers and toes came back and I have had no residual problems. But this situation made me really angry! And this is a major reason I would not recommend this company – Shark Lady Diving.

However, I do highly recommend cage diving! It is a bucket list experience and gives you a totally different perspective on sharks. I do feel some ethical dilemmas with the baiting of the sharks everyday, but at the same time the only way to increase awareness and encourage locals to protect the sharks is to create businesses that bring in money to the local community.

We spent our last day visiting wineries in the area including our favorite – Creation Wines in Hemel en Arde valley. We did their 7 course brunch wine pairing and it was excellent as usual. Then to top off the trip we finally got to see some whales in Walker Bay! They were far away and we only saw one breach but it counts! We can finally mark that off our bucket list!

More pictures from Cape Town and Shark Diving!