Hello again,We are officially half way through our international rotation and we keep saying how difficult it is going to be to leave. It feels like we have been here much longer than a month due to our busy days. South Africa is truly an amazing country with so much to offer. Being here as long as we have has allowed us to fully immerse ourselves into the Cape Town culture. As we have been fortunate enough to make wonderful friends who have shown us what it is really like to be a Capetonian. We had a surf lesson, learned how to sokkie, and got invited to a braai. If you don’t know what some of those words mean that’s okay, I didn’t either. Sokkie is a traditional South African dance, and a braai is their version of a barbeque.As I mentioned in my last post due to the currency exchange being extremely in our favor we are making this the trip of a lifetime. Since last I shared with you I have crossed many things off my bucket list. I jumped out of a plane 9000 feet above ground, swam face to face with sharks, and spent an entire day as an elephant keeper. After almost everything we do here I say, “That was the most incredible thing I’ve ever done.”, then we go and do another incredible activity the next day.When we arrived the four of us made a list of things we had to do during our time here. The first thing on Travis’s was skydiving. We booked our day with Cape Town Skydiving and next thing I knew I was soaring above Cape Town with a man from New Zealand strapped to my back. Being completely honest it didn’t hit me that I was about to jump out of a plane until he opened the door. Then it hit me. Then I was falling. There really is no other feeling like it. It’s the most perfect mix of absolute terror and complete freedom. Then even after the parachute has been pulled it’s such a bizarre feeling floating above the world.If you had told me a month ago I was going to be completely submerged in the ocean inches from about eight sharks I would have laughed in your face. If you know me, you’ll know that my biggest fear is open water. Imagine me curled up in a ball, hyperventilating. Yeah, not my favorite thing. I love the ocean, just not being in it. So how did I conquer my fear do you ask? Well, when you slip on a wet suit during the trip of a lifetime, you throw away your fears and you jump right into the cage. I knew I would forever regret not doing it, so I took a deep breath and went for it. Was it terrifying? Yes. Was it incredible? Absolutely. Some tips for if you ever go shark cage diving, don’t wear a hat because you will lose it, and sit on the top deck in case anyone gets sea sick.While we have done more unbelievable things than I can wrap my head around I have to say my favorite would be our day with elephants. We took a six-hour African road trip from Cape Town to Plettenberg Bay. The drive was along The Garden Route, which is a gorgeous drive full of mountains and cities along the coast. Everywhere you look looks like a postcard. We stayed the night in a nice little backpacker’s lounge and started the next day nice and early. Upon arrival we were introduced to our new friends Jabu, Thandie, Marola, Tabo, and Tomela. These five African elephants were found in the wild either injured or without parents and then brought to this sanctuary for safety and recovery. We gave them their morning brushing, took them on walks, and fed them lots of pumpkin. During our day as elephant keepers we learned so much about these amazing animals. We got to see firsthand how incredibly intelligent, and loving they are. What was most amazing to me was how the elephants whose trunks had been injured have adapted and learn to grab food in new inventive ways. The entire day was unforgettable and something I’ll treasure for the rest of my life.In regard to the pharmacy aspect of this trip, we have had just as eventful of a time. We adjusted pretty quickly to working up our patients via hand written notes. The most difficult part proved to be just the lack of information in the notes. More often than not I would ask my patients for the information I could not find or wait until the doctor came for their rounds. The doctors have been surprisingly open to answer questions or accept recommendations I present for the patient’s medication. During my work up of patients if there is a recommendation I have for their medication regimen and the physician is not around I leave a sticky note for them to see next time they visit. It might not be the most advanced form of communication but it’s the best we can do.Tygerberg is a teaching hospital so groups of medical students rounding with a physician is a common sight. Listening in on these rounds is one of my favorite things to do as I either learn new things or get refreshers on things I already knew. Sometimes they even ask us pharmacy students questions and we get to teach the medical students. Very often when I tell people I’m a pharmacy major they assume I only learn about medications for six years. In reality I would say only about two of those years really focused on medication. To fully understand how medications work we needed to have full understanding of the human body, as well as how it is effected by disease. If we don’t understand the problem how are we expected to fix it?In case you didn’t know I was diagnosed with type 1 diabetes three years ago. This means that my pancreas does not produce the hormone insulin, which is necessary for your cells to absorb carbohydrates from your diet as fuel. Without insulin your blood sugar raises to dangerously high levels that leads to many complications. The difference between type 1 and type 2 diabetes is patients with type 2 diabetes may still produce insulin, just not very effectively. Patients with type 2 diabetes can take oral medications to help their body use the insulin that they produce more effectively. Patients with type 1 diabetes, like myself, must rely on insulin injections to survive, as our pancreas do not produce any insulin so oral medication would have no benefit. This is a very basic explanation and there is a lot more to diabetes but for the purpose of this post I just want you to understand that I need insulin to live. This worries most people, but I’ve learnt to deal with it. However, imagine my worry when I realized I didn’t bring enough insulin with me to South Africa.I know. I know. How could I do this? I honestly still don’t really know but somehow, I brought one vial too few. One vial of Humalog insulin lasts me about two weeks so, I didn’t have enough insulin for my last two weeks here. As soon as I found this out I told my preceptor Dr. Coetzee and he amazingly got me a prescription for two more vials that day. He was a bit worried about me to say the least. It was a fun experience going to a South African retail pharmacy and getting my prescription filled. The two most interesting parts of the experience was how cheap the name brand Humalog insulin was, and that you take your prescription in a small cage to the front of the store and pay there.There never seems to be a dull moment here, and I’m glad I get to share my stories with you. We have two more weeks left here in Cape Town and I can’t wait to see what they have in store for us. We are finalizing our community outreach project this week and will be presenting to three groups of about 40 community-based health care personal our final week. I plan on creating one more blog post before I leave so be on the lookout for that!Talk to you soon,Mitchell

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