around the world in eighty hours

OK, not eighty, I am exaggerating...it will only take 63 hours to get there.  The story of arranging such travel, however, has played out over several months.

How does one get to Lubango, Angola?  Much to my chagrin, Southwest is not flying direct from Columbus.  Bags would've flown free!  This left me with an origin, a destination, and some loose advice from the hospital's visit coordinator, Norman Henderson.  The advice was as follows:

• When you start looking into flights we strongly recommend that you avoid Angola's capital, Luanda.  It's a zoo and transiting through there will cause you stress, cost, and maybe even danger.
• The best are non-stop flights from Windhoek, Namibia to Lubango on Sunday, Wednesday, and Thursday mornings (their schedule could change).

So there it was.  Avoid the capital and catch a thrice-weekly flight from an African country that I had not heard of.  OK, go!

It was essentially time to search the internet and figure it out.  Obviously, I found myself on Google.  I learned that in order to connect through Namibia I had two choices: a direct flight from Germany or an overnight through Johannesburg.  I chose Joburg.  Care to know why?  TURKISH AIRLINES.

Turkish Airlines?  I thought you were going to Africa?  I am, through Istanbul, Turkey.  Way back when (i.e. September 2012), before I had even formally applied for this rotation through Ohio State (!), I booked a flight.  While we are on the topic of Turkish Airlines, check out this unfortunately placed advertisement of theirs!

The task remaining was to arrange the fight from Joburg so as to connect with that three times a week airplane to my final destination...

Have you heard of Kayak?  If not, then you are welcome.  Kayak's international cousin, with whom I became well acquainted, is Vayama.  It was as simple as entering the cities and dates and clicking, "Search."  I found a perfectly timed flight for a good price and booked it the same day as my Turkish ticket.  All was well!  Right?  Wrong.

One of my flights was cancelled.  Did I purchase the travel insurance?  No.  Did I book through a guaranteed broker?  No.  I was pretty sure that my levels of money and stress were headed in opposite directions.  I was put in touch with the Change Department over at Vayama and, much to my surprise, these folks were AMAZING.  Prompt e-mail replies, personal phone calls, and all the information I asked for came without much fuss.  It all was coming to a head as I left for a weekend trip to Baltimore with my buddy Joe.  I had a sense that timing would be of the essence this weekend and so prepared the following cheat sheet.

A good thing too.  As we were driving through the heightening Alleghenies of Pennsylvania, jamming to some vintage Guster, the tunes were interrupted by the sounds of an iPhone.  Sure enough, it was my friends in the Change Department.  Prepared for the worst, I received the following:

• "We have contacted the airline (Air Namibia) for alternate flights but they are unable to provide any other alternate to re-protect your itinerary.  Hence it is only possible to cancel this entire reservation and provide a full refund for this ticket due to involuntary airline schedule change."

Thanks Vayama!  With no protection on my original booking, I gladly accepted the refund and re-booked.  Only three weeks before my trip, I received another schedule change, though this one was, "minor."  All in all, the only remaining question mark is a 55 minute layover on the way there.  Here's hoping!

So, there it is: four countries, five planes, sixty-three hours.  They say the shortest distance between two points is a straight line.  What if that line happens to be 7,232 miles long?  I'll be sure to let you know when I get there!

let's do some shots!

DISCLAIMER: some of the links herein and after are not for the squeamish.

There is this eerie moniker in the infectious diseases field called, "Sub-Saharan Africa," and that is precisely where I am headed.  There are all sorts of crazy tropical illnesses in addition to things like malaria that we Ohioans don't have to deal with.  Thankfully, the magnificent folks over at the CDC provide country specific, "Health Information," pages.  Put another way, I'm trading lions, tigers, and bears for nematodes, protozoa, and flies, oh my!

There are many precautions and preventative measures that one should undertake before a trip to Sub-Saharan Africa.  Thanks to the international community in Columbus and the global reach of the University, I had no issue scheduling a travel health appointment.

So on December 11th, I trudged over to the Student Health Center for my tune-up.  I woke up a little late that morning and had woefully overestimated the temperature; making for a flustered, cold Zach on arrival.  I settled in the waiting room and undertook normal actions: people watching, casually eavesdropping, and reading outdated magazines.  As I was now contemplating what this appointment would entail, the ladies at a nearby nurses' station started to discuss how much they are attracted to Pitbull.  As someone who considers Don Draper central to my self-image, I have some especially serious disdain for the poor grammar cows of Chick-fil-A and everything that is Pitbull.  So flustered, cold, waiting Zach is now officially on tilt and frustrated with the world that this, "artist," has enamored fans...but I digress.  Soon enough, thankfully, my name was called and I was off to the exam room.

I found myself in a standard examination room with a genial, middle-aged nurse practitioner with curly hair named Sandra.  We reviewed my medical history and medication list.  I received a cursory physical exam.  This was all well and fine but we were skirting around the crux of this whole deal: HIV and vaccines.

HIV/AIDS is a very real concern in Angola.  Estimates of HIV infection rates range from 1.6% to 9.4% of the population (c.f. 0.3-1.1% in the USA).  Working as I will in an environment prone to contact with body fluids and blood, it will be as important as ever to take proper precautions.  In the event that I am exposed to the human immunodeficiency virus, I left my appointment with a prescription for a, "HIV PEP Kit."  This Post-Exposure Prophylaxis Kit is a 7-day course of HIV medication that attempts to prevent infection after exposure.  As if this isn't crazy enough, if I am indeed exposed I have to get back to the U.S. to continue medication within those seven days!  I promise to wear gloves and avoid needle sticks...

Does anyone actually know the answer to, "when was your least tetanus shot?"  I had performed the always onerous task of assembling my vaccination record from PDF's on my computer, tattered cards initialed in 2005 documenting something or other, and a printout from the College of Medicine.  Wading through this mire it emerged that I was due for four vaccines: yellow fever, hepatitis A, typhoid, and polio.  That's three shots and a set of pills folks.  I decided that I was not interested in coma, death, delirium, diarrhea, and/or paralysis and so agreed to treatment.

Sandra thanked me for my cooperation and wished me well on my trip.  I was then led down the hall by the incredibly bubbly Lisa who was to poke me with needles.  Lisa was hilarious and of recent African descent herself.  She had lots of questions and was just a genuinely great person.  In my rush to make it to the appointment, I had skipped breakfast.  This terrified Lisa.  She claimed to have had many patients pass out after receiving the hepatitis A vaccine and so insisted that I lie down on a gurney in order to receive safely.  I obliged but was taken aback when she proceeded to put me in DEEP Trendelenburg position.  Two shots to my right arm and one to left.  I felt totally fine and found it a little funnier than Lisa when I feigned weakness on standing.  With that, I was free to go: prescriptions in hand, shots in arms, and Pitbull still spewing some rage in my head.

Fast forward a couple weeks as I am now sitting at the kitchen counter in good old Lima.  Thanks to the Affordable Care Act and the fact that I have not yet turned 26, I now set out to fill the prescriptions on the parental insurance plan.  For those that have, "jobs," and, "benefits," please know this is a FANTASTIC feeling.  So I call up Medical Mutual and price them as follows:

Vivotif $46.86 (typhoid vaccine)

Kaletra $753.33 (HIV medicine)

Combivir $218.92 (HIV medicine)

procholperazine $1.77 (anti-nausea)

I do not exactly have $1,020.88 sitting around.  Congratulations to the family on having met our deductible for the year and to me for not procrastinating any longer than December 27th because I paid a grand total of $0.

There you have it!  I am vaccinated, medicated, and prepped to face all the germs that Angola might care to share.

you're doing what now?

Thanks for stopping by.  Here we go.

--

"Life begins at the end of your comfort zone." -Neale Donald Walsch

I ran across these fine words sometime, somewhere in the last month.  I feel that to grow is to make an effort to understand others, to try new things, and to think in different ways.  I am undeservedly fortunate to have an opportunity to do these things.  For the month of February 2013, I will be serving at a hospital in Lubango, Angola.

Here, I hope to catalogue all that is this opportunity lying before me.  I will try and update often and honestly.

Alright, let's get the bricks and mortar taken care of.

Who: Zach Rossfeld.  Yeah, that's me, pleased to meet you.  I was born and raised in Elida, OH.  In the pursuit of higher learning (and a good time), I travelled down to Columbus for undergraduate and have remained at The Ohio State University for medical school.  I like to think I'm a pretty affable dude, avid sports fan (i.e. the Buckeyes, Reds, Grizzlies, and Federer), and listener to all musical genres.  I am applying Internal Medicine/Pediatrics for residency and am in the thick of interviewing.  So, basically, in the words of the Sugar Hill Gang, "ya see I'm six foot one and I'm tons of fun, and I dress to a T."

What: Global Health Elective.  As part of my fourth year medical school curriculum, I have opted to complete one of my elective months abroad.  I am very thankful for the Office of Global Health at the College of Medicine.  There are tens of fourth year Ohio State students who embark across the globe every year.  The folks, especially program manager Jessica Small, have been very resourceful and endlessly supportive of my trip.  It has been especially interesting considering that I am the first Ohio State student to visit Lubango.  Establishing a new clinical site for future students and adding to the Office's Rolodex have proved mutually beneficial for all parties.

When: February 2013.  Wheels up from Columbus on February 3rd and returning March 4th.  Much more on my travel arrangements later...

Where: Evangelical Medical Center of Lubango is the clinical site I will be visiting.  It is a tertiary referral hospital with about 40 beds.  Affiliated with a rural, "bush hospital," CEML serves an urban population of over 100,000 people.  There is quite a bit of information on the website and I encourage you to look around.

Why: A perfect marriage of need and interest.  Angola is a country in great flux.  After gaining its independence in 1975, civil war ravaged the country and its people until a lasting ceasefire in 2002.  Get this, the life expectancy is 54.6 years which ranks 201st in the world.  The top killers are influenza, pneumonia, and diarrheal illnesses.  CEML sees some of those 50% of Angolans without other access to care!  Obviously, the medical need in Angola is much more vast than I can hope to fully appreciate.  I am, however, motivated to learn and apply myself where there is such need.  I have heard the overwhelmingly positive study abroad experiences of many friends and am saddened that I was unable to do so in undergraduate.  Consider this global health elective me finally checking something off that educational and life to-do list in a meaningful way...

--

Much more to come.  Happy New Year everyone!  -ZR