My family joined me in 1994 on the Semester at Sea program: three months at see with a ship full of college students. This was our first visit to Africa. I offer it for the fun it reflects as well as my suggestion that you revisit The Poisonwood Bible by Barbara Kingsolver. She reminded me of how incredibly lucky my family and I have been.
This first segment covers the transatlantic trip from Santos, Brasil to Cape Town,
South Africa. I was the only physician on board for students and staff. The second segment speaks to our short time in South Africa.
The crossing of the South Atlantic in February 1994 stands out as one of the most stressful times in our married life. The ship was limping along and halfway across, we were warned that many of the port trips would require modification as we would arrive later than scheduled. The ship’s power train, at half power, meant we had to rethink of things normally taken for granted: ventilation, water, and fresh food all had limitations placed on them before we reached land. It was nearly two weeks at sea as we traveled half speed.
While I had gone to great pains to brush up on travel medicine and illnesses not typically seen in the US, I got my comeuppance in that the most common illnesses on the the boat during this leg were predictably, related to behavior and the common cold. This included my family. Most students lived four to a ten by ten room and there was little open space in the ship to find privacy. You mix students from across the US and a few foreign countries, pack them in tight, and colds are to be expected. Before Covid, I was there for a superspreader event. That environment breeds weirdness as well given that the average age of our five hundred students was probably eighteen years and eleven months.
The heat of the South Atlantic found our students confronted with the reality of scarcity--appropriate given Brasil and South African destinations. Many had the habit of taking up to three showers a day; this was now confounded by a shortage of fresh water, not to mention hot water. We used paper plates in the dining hall at the end of this leg as there was not enough fresh water for dish washing. To relieve tension, the captain opened up an ice cream parlor for a few hours one day mid point, but this did not placate a student body used to getting pretty much anything anytime.
The school was a scene of tension. Despite being fully engaged, Jane and Kernie were learning that there are limits as to how much a parental unit can influence school behavior. This is a side to educating prairie children in the last century that is never discussed despite our romanticizing that time. Of course, “spare the rod and spoil the child,” was operational in those days so at least superficially, there was “compliance.” On reflection, the education at home on the prairie was about the school of hard knocks and not necessarily geography or math lessons. Darby (fourth grade) was in tears because of the volume of homework despite the fact that we knew, when compared to the time needed at home (school plus homework), was much less on this trip. Her school work on board was focused and without the distractions of twenty-five other students. The environment was both stimulating as well as stimulating for all the kids. Amber withdrew on this leg, staying in her room unless forced to come out and she was easily moved to tears whenever she was asked to help or be included in a group activity. I felt for her in that she had no peers on board, being a freshman in high school.
Amber was too old for the kids that hung with her in the ship board school and she was not at the social level of a college student, as young as they seemed to us. Adding to this was her one peer, Gabe, always there for a comment, usually critical, and espousing the education he was getting, “hanging on prom.” That would be the promenade deck where most social interactions occurred. He actively tested Amber’s willingness to at least consider a cigarette or a beer, all the while plunging one of his skinny fingers up his nostril with no self-consciousness whatsoever. He told Amber she was backward, totally out of it, living in a bubble, a loser—just what she needed to hear. Kernie confronted him and redirected him in no uncertain terms. One of the RD/educators was fascinated by this approach. Modern education theory, she suggested, mostly tried to influence the pupil through questioning (the so called Socratic method) to come to the right decision the emphasis being, learning on their own and coming to the proper conclusion on their own. Kernie’s approach after telling him to back off on Amber? “You are the idiot and you have to ask yourself, what does a college student stand to gain hanging with you, exactly? They may even be taking advantage of you, Gabe. You are fourteen years old! Think about that.” To all our amazement, while taking this message badly, he continued to seek Kernie’s input throughout the rest of the voyage regarding his activities and thinking.
I dressed nicely one night in the Union; Gabe was fascinated and curious. “Why are you dressed up?”
“I took my wife out to dinner tonight, Gabe.”
This non-sequitur given our uniform and standard eating options left him dangling, unsure what to think or do. What does it say about me that I especially enjoyed that?
The medical issue to be sorted on this leg was for us, the famous conjunctivitis epidemic. Why famous? I have never heard of this situation before or since…..Conjunctivitis is typically a benign self-limited condition in the USA; there are tropical versions, never seen by me, that could be much more serious. While I could work with students one-on-one with this condition as they presented in clinic (or on the prom, or in the dining hall while I was eating) , this was in fact a public health issue. It was a widely communicable disease and once established, I did not have an effective strategy for limiting it. The environment could not have been worse: four to a room and crowded common rooms. Students were as young people everywhere, especially likely to lean in on denial as a compensating strategy when faced with a topic and choices that were not pleasant or easy.
The group of students who had flown to Manaus while in Brasil had subsequently gone up-river on a chartered steamer. This the source of our problem. The Public Health doctor in me was able to sort after the first few cases surfaced, that there was a common source for the infection: all students initially were from the same boat and they reported sharing a common bathroom with the rolling towel style for drying. Someone with conjunctivitis drying their hands or face on the towel left a wonderful mechanism for spreading the infection. The symptoms of the condition were pretty familiar: a swollen gritty sensation in the eyes that was irritating and made for tearing. In this case, the tears were not clear but rather clouded with pus. Alarming to me as I had never seen cases like this, was the hemorrhagic discoloration (ie bloody) of the sclera in many of the cases. I read up on the condition and everted eyelids searching for tell-tale signs of trachoma. None were found. I did find swollen lymph nodes and conjunctival “cobble stoning” which I thought supported the typical viral cause for this condition.
Being a therapeutic nihilist, I appreciated this would likely burn itself out with or without treatment. Being the complete family doctor, I recognized that I had to offer something to the students so as to feel reassured and know that something was being done while nature did all the rest. I had an inventory problem. In the States, each person would have their own bottle of Bleph 10 (chosen mostly to cut down on the bacterial overgrowth). I had one bottle of this and initially twelve people with the condition, needing two drops each eye two to three times a day. I had some gentamicin drops as well for the sulfa allergic. I had a few bottles of napthcon A which is more of a soothing medication. The nurses and I each carried a bottle of “something” and had students come in to the clinic for twice a day administration done by us so as to preserve the medication. Few did this, so we took to having it on us as we ran into them during the course of the day. In addition, we did an educational piece, one of the first, “Rick and Randy” shows of the voyage. I would describe the condition in dry technical terms and Rick would pointedly hold up his hand to stop me to translate:
“The adenovirus typically takes a few days to incubate at which time there is swelling on the conjunctiva, formation of an exudate, and tearing along with some adenopathy.”
“So this bug gets in your eyes, and it is like bleach so your eyes get red and swollen and puss will form and drain down your face. Then your neck gets these swollen balls”
We did the public health messaging after the entertainment. Scrupulous hand washing and non-sharing of towels and clothes was suggested.
Right.......
In the Union, within a day or so, we saw a popular frat boy using the microphone as he did his schtick, wipe his goopy eyes with the right hand while holding the microphone with the left and then transferred hands over and over at which time he transferred the microphone to the next non-infected frat boy who in turn, did his schtick. We cautioned our girls to stop using the hand rails on the stairs…. Happily, our little corner of the boat stayed safe and dodged the dreaded pink eye. I had two students with non-resolving inflammation and scleral hemorrhages. I actually made a ship to shore long-distance call to John Peterson O.D. for advice. He suggested, based on what I told him to stay the course and in South Africa, to get those with prolonged symptoms to an eye doctor. That advice I delivered. One of the girls did get better and I found out shortly before landing, that she had scored prednisone eye drops from one of the girls on board. My training was that steroids in the eye really (REALLY) need supervision by someone who knows what they are doing, as there are significant possible side effects. I read her the cautions and she reassured me she would take care of things in port. It turned out, she did not and would still being having problems on the way to Mombasa.
Part of evaluation for conjunctivitis included fluorescein staining which I also did for yet another Frat boy while we were docked in Brasil. He woke me up at 2 AM to report that he had gotten super glue in his eye. I was dumbfounded. “How did you do that?” I asked sleepily. “You don’t want to know, “ his reply. I thought this through and decided there was not much to do. We used a lubricant and observed, the erosions healing slowly with the passing days. The conjunctivitis epidemic while interesting to me, and gross to the students afflicted with or dealing with the afflicted, did burn itself out. I felt challenged but also, once again, master and commander of what I could control which as I thought about the program and treatment, was not much. God heals the patient and the doctor collect’s the fee.
There was another medical problem that was of a one-on-one nature. A lovely young Coed, Amber’s Health class tutor, suffered from paraplegia. My hatred of motorcycles was unchanged; her example is why. She was bright and full of life though very much wheelchair bound. On the Atlantic crossing, she hung with fellow students on the pool deck in a bikini. She sun bathed on an inflatable raft and the sun being hot, burned her ischial area on the right. My experience with this was mostly with diabetics and a few paraplegics. All were by and large non compliant with the treatments and in some cases, I had been able to see pelvic bones through the wounds. She had a small area of full thickness loss of skin but much more ( a fifty-cent sized area) of indeterminate loss. We began a pattern of hydrotherapy and dressings designed to wick away fluid and prevent more pressure damage. She appreciated the effort and worked hard. We did daily measures of the cross sectional distance and estimated depth and plotted a graph as a visual aid. As is always the case, she did not heal well. Each and every port, we would have a discussion about going home where more definitive treatment could be offered. I pushed this harder when she told me her father was a neurosurgeon in Boston. I remember thinking, “what can go wrong?” Everything could go wrong! We both hung in there and she had some adventures on this trip but did complete it. Her father would look me in the eye and shake my hand in Hong Kong and thank me for not giving up on her. Only then, did I feel good about her management—and neurosurgeons.
The Frat boys got squirrely on this crossing: one night after drinking more than the recommended amount, they vandalized the ship, pulling down the fluorescent “to the lifeboat” signs and frisbee’d them over the rails in the dark. It apparently was quite a show. The captain, on hearing this halted all sales of alcohol on the ship and for the damages demanded money for repair. No one came forward but the notion of group punishment for the sins of a few put an interesting dynamic in a group of college students seeking and constantly discussing, “community.” The Frat boys skated but the more responsible students canvassed the community and came up with the money for damages. They apologized for the incident to the captain. The bar was reopened.
The nights in the mid-Atlantic were beautiful. I remember seeing stars with a minimum of light pollution—a first in many many years. One night, one of the professors, Wen Fang (Poly Sci) chatted me up as he practiced on a penny whistle. It turned out, he could reproduce virtually any tune after hearing it once or twice. He demonstrated this talent and I asked if had any Chinese tunes he could play to us. He could not think of any. I offered one up: I had an album of Arlo Guthrie and Pete Seeger in concert. Seeger, on that album, presented a tune from the Chinese revolution that involved a lot of whistling. I whistled it. Fang’s face grew incredulous. “I know that song!” He said. “It is an old army tune,” I told him. “I know,” he replied, “It is an old army tune.”
“How do you know that?” I asked.
“My parents were in the army,” he said with a wry smile.
I told him of Seeger’s interpretation of the song—-telling the troops to pay for what they take, to not abuse civilians, and otherwise demonstrate the revolution with virtue. Fang smiled again.
This bonding led to our teaming up for the mid Atlantic Olympics—in our case, a volleyball tournament. Fang was six foot two. Joined by two coeds, we played decently and beat out many younger than us in the tournament but fell badly in the quarter finals, 15-2. The pitching of the deck killed my serve as, if not timed right, would go up into the lofty nets surrounding the court, or into the dividing net. I took it personally. So did Fang. We were signed up for doubles, so redemption was around the corner. We did not make the quarterfinals in that tournament.
As we approached Africa, just a few days out, the air grew colder. The captain grew more social and we had several nights visiting his lounge. He made plans: a sailing dinner in Mombasa, time in Hong Kong, a fancy hotel in Penang. The girls were treated to pies, “just because” and he was adamant that they not share with other kids. We parents were growing wary of the captain and his favoritism.
1994 was a time of change in South Africa. As we approached Cape Town, the students discussed the history of South Africa and the coming national elections extensively. I reflected on Uris’ The Covenant and Paton’s Cry The Beloved Country. I was primed and a bit apprehensive about what we would see even with this optimistic approach. They assigned party membership and had an election anticipating the real thing. The election posters posted on the ship were priceless.
Eleven days at sea was exhausting. Aside from the rolling of the ship, which for me induced a mental dullness and an extra need for sleep, was the fact that when traveling west to east, every couple of days, we had to advance the clock an hour. That sounds trivial, but added to the lack of activities and the lack of privacy, not to mention the heat and humidity, we all went a little crazy while being sleep-deprived.
Things were tense but then, we were able to celebrate Jane Johnson’s (our new best friend) birthday. There was a light at the end of the tunnel and our friend gave us a cause to celebrate. February 7, 1994 we woke up and found that virtually every corridor had a Xerox of Jane’s face and the announcement regarding this very special day. We dressed up for Jane’s birthday—Kernie in a a very stylish dress on loan from a student, Kristen. In the dining area an ice cream cake was presented as the finale. As we could not finish it, we shared this treat with some of the RD’s and the four amigas (student friends of Kernie’s). One of the older traveling couples were celebrating their fiftieth anniversary and so, they got some desert as well. We danced to Sinatra in the Union hall, and I showed off my French braided hair—one of the last times I would be able to do so as my thinning hair was becoming incompatible with that approach to styling.
view from the stern looking forward: SS Universe
Rick and Randy outlines potential problems to be considered, port by port as we gave "Pre Port Tips."
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