BOTHA’S HILL, South Africa—“So wait…you mean you’re not a medical student?”

Though I’m inwardly groaning, I smile and nod at this tall, overdressed woman. She appears to be the substitute dietician, and she appears to know everything about me—from my name to the fact that my co-intern departed last week. I’ve never laid eyes on her before in my life.

“Right. I’m pre-med. I’m still in college.”

It’s about 10 A.M. on a Thursday. I’ve been at work at the HIV clinic for 90 minutes, and it’s already been a long day. I can predict exactly how this conversation will go: for the umpteenth time since my arrival in South Africa, I will have to explain that no, although I’m 21 years old, I’m not yet in medical school. We Americans do things differently.

The novelty of this conversation has long worn off, and I would much rather be playing peek-a-boo with the two-year-old boy sitting in the waiting room in front of me. He doesn’t understand a word of English, but things are simpler that way sometimes. Peek-a-boo transcends the English/Zulu language barrier, and for this reason, Thursdays—the day when the pediatrician is on duty in the clinic—are my favorite days at Ethembeni.

Then the dietician drops the second-most common question I am asked in South Africa: “So, what’s different about our country compared to yours?”

This is a question that I find unnecessarily difficult to answer.

The education system, obviously, is a difference I spend a lot of time talking about. The fences that line middle- and upper-class neighborhoods also come to mind. I have never seen such a concentration of electric fences in such a widespread area as I have in my travels around the greater Durban area. There’s greater poverty here, of course, and we don’t have HIV clinics like this at home because there’s no need for them. Throw in the obvious stuff—different language, different majority race, different indigenous animals—and I can generate a pretty good, if uninspired, list.

But after that, I start to get stuck.

Well then, surely the food or the TV shows or the rhythm of life? Every evening here, I walk home from the hospital, check my email, read a little bit, eat dinner (last night: spaghetti bolognese), and watch television with the family I live with (their favorite shows: Survivor, Gossip Girl, and Will & Grace). Sounds pretty much like what I would be doing at home, except here, I get to watch a beautiful sunset over the Valley of 1,000 Hills every night, and though it’s the middle of winter, we still go to the beach on the weekends. So there’s that, at least.

Eventually, the dietician grows bored of our conversation. Maybe it’s just that I’m grumpy—close to 100 patients come through the clinic each day, and registering them and sorting through their files is a monotonous task in this computer-less system—and not willing to engage in intellectual debate this morning.

I turn back to the little boy. He’s been tugging at his mother’s skirt, but upon realizing that my attention is back on him, he toddles over to my desk, and we resume our game of peek-a-boo.

Or maybe it’s just that things really aren’t so different after all.