My Escapes from Medicine

Medicine. Travel. Photography. Investing.

[seekingvalueinlife]

OPT: A costly price for vision

In the early days of investing I came across what I now understand as a speculative Biotech stock. Opthea Limited (OPT) at a market cap of just over AU$700 million was not a particularly small Biotech company by the time I had started to look into it. However the key here is that it relied all of its future value on one drug - OPT-302 which acted to block two members of the vascular endothelial growth factor family, namely VEGF-C and VEGF-D, which cause blood vessels to grow and leak. The promise it was selling was an alternative/combination treatment for the eye diseases wet aged macular degeneration (wet AMD) and diabetic macular oedema (DME).

“The science behind the promising intervention/therapy always makes theoretical sense.”

So where did this company take me? As a newly-fledged doctor, a couple of days reading laboriously on the “beauty of passive investing”, and regrettably a dose of financial optimism that only a beginner could have, I became convinced by a Facebook post in a doctor’s investing forum that OPT was the next big thing. The science just seemed to make sense and previous trials (AMD Phase IIb & DME I) had shown reassuring results. However I would soon find out that my preconceived expertise in medicine and what I thought was an upper hand in understanding and digesting medical research was in fact my downfall. Like many biotech stocks that had come before it, some which succeed and plenty more that fail, the science behind the promising intervention/therapy always makes theoretical sense. For a potential therapy to get so far that institutional investors (with MD analysts under their employ) to value it at AU$700 million you best believe that the science makes sense. That understanding is already factored in the price. My misconception that only a handful of practising doctors who invested on the side could grasp the science allowed me to erroneously value a company which ultimately was based on speculation.

The amount I lost in the end is no small sum: $463.65 across 7 trades over 2 months (with free brokerage). 

My investment into OPT relative to the S&P/ASX 200.

However I remain positive that I went through this exercise, having gained more experience and investing knowledge. Here is an outline of the trades and what I have learnt:

Trade 1 BUY @ $2.96 on 25/05/20 - I was under the belief that this stock was due to rise to $5.20 based on a Goldman Sachs price target and climbing prices secondary to the release of DME Phase IIa results. I learnt that price targets from analysts are not a sure thing and should be taken with a grain of salt. What is more important is understanding how they arrived at these targets, the timeframe for a share price to reach it and whether this aligns with your perspective.

Trade 2 BUY @ 3.28 on 05/06/20 - I bought at the peak of the price on the back of the DME Phase IIa trial results. While the results were generally positive they did not meet the optimistic expectations that many including myself were hoping for. The important thing with speculative stock is that they trade on the market expectations and even with a good result, if it is not as significant as the one that was anticipated, it will drop. And drop it did. I later learnt that a risk averse means of approaching this would be buy on the speculation, sell before the result.

Trade 3 BUY @ $2.56 on 26/06/20 - In an attempt to average down, I made this purchase at the lowest price of all the buy trades I made.

Trade 4 BUY at $2.63 on 23/07/20 - With the ASX announcement release that OPT would be presenting their DME IIa results at an international ophthalmology conference that weekend, the price once again rallied. I was hesitant to buy on this day but I finally made the commitment to practice what I had learnt from an earlier trade of “buy on the speculation, sell before the result”. I assured myself that I would sell before the day was over.

Trade 5 SELL at $2.73 on 23/07/20 -  I sold later that day at $0.10 higher than my buy price and made a small dent in securing back some of the losses I had made previously.

Trade 6 BUY at $2.79 on 27/07/20 - After reviewing the slides from the ophthalmology presentation I was convinced that the results showed a significant difference in treatment for a subset of patient’s who were refractory to previous treatment. I put in a sizeable percentage of the portfolio (~$4000). However once again I made the same mistake of misunderstanding the market expectation and that a significant result in a small patient population could justify a 16% rise in share price.

A significant difference between mean change in BCVA baseline at 8 weeks and 12 weeks follow-up appeared promising but as a I discovered a second time was not enough to satisfy the market.

Trade 7 SELL at $2.63 - I sold out of this one rather late, having told myself that I would put a stop loss at $2.70. However when it came to watching the price drop, refreshing, wishing it would change course, refreshing, further red, it can be quite overwhelming. The message is clear, this kind of short-term trading that relies on irrational greed and fear is not for me. 

I have sold out my position in OPT and it does give me some relief. Just to reiterate I am $463.65 down and humbled. It may be a costly mistake but hopefully it is just a hurdle for my future in finding the value in investing. OPT will just be that wild rollercoaster I’d have far more enjoyment watching from the safety of the ground.

[seekingvalueinlife]

January 2019

08.02.19 - Prague 

Late morning in Prague - Life admin, making breakfast, relaxing. 

Prague Castle - Went up for the views and to observe the beautiful stained glass in St. Vitus Cathedral. 

Havelska Koruna - Had dinner at this cafeteria-style restaurant that served Czech traditional food. We arrived with less than 1 hour before closing and it was quite empty which thankfully made it less confronting to order food. I had creamy mushroom with beef and bread dumplings which was satisfying although I would have enjoyed two pieces of meat instead of only one. 

Nase Maso - Beef tartare was fresh and the texture was so smooth. The flank steak was grilled so well, although it was a little undersalted to my liking. I wish I could’ve brought myself to pay for a nicer cut of steak or even the dry-aged steak.

09.02.19 - Prague

Paid bond back to Zuhdi for his temporary tenancy - So glad that I was able to have someone cover my Liverpool rent for the entirety of my travels overseas and for the hassle to be over.

Naplavaka Farmers Market - Saturday market with many food stores that sold a diverse range of traditional and local foods. Part of our lunch included a great sausage that had a crunchy casing and meaty filling.

Franz Kafka - Pretty neat moving sculpture that depicts Franz Kafka and his idea of metamorphosis. There was a slice of his nose that was in the wrong place though.

The train ride from Prague to Krakow on the Leopold Express - European trains are quite comfortable to travel from city to city. Made a sandwich from some cheese, meats, bread and salad we bought from Albert supermarket beforehand.

Arrived in Krakow - Our Airbnb has a cute IKEA interior, the building and courtyard are everything I imagined eastern Europe to be. 

10.02.19 - Auschwitz

Auschwitz/Birkenau Museum - 1.1 million people were systematically executed in 5 years. That’s fucked. Humans can be so cruel. It was staggering to see the size of it all. It was real and it happened. However, I don’t know if it’s because I had studied it so much in history or if it’s because I’ve been to Unit 731 and the Killing Fields but somehow I was numb to any sadness. 

11.02.19 - Krakow

Krakow - It’s so clean

Hex Boardgame bar - Introduced Tizzle, Celeste and Bernie to Dix

Escape Room 666 - Based on an exorcism of a young girl, I found this escape room to be an extremely immersive and thrilling experience. From the candle flame marks on the wall to a complete confession room and coffin integrated into the mechanics of the room, we were left solving and guessing well over an hour. All that for only $9 per person, wish we had activities were this cheap in Australia. 

12.02.19 - Budapest

Walking tour - Budapest was way too windy and even with a semi-interesting tour guide, the walking tour was unbearable and we were freezing our butts off.

Lunch at D15 Etterem - We ended up at this corporate cafeteria following a recommendation from a blog. Not what we expected and ended up paying a little more but the food was still great for cafeteria food. I had the roast duck which was really enjoyable but I was disappointed by the serving sizes.

Szimpler Kert - Didn’t have any expectations for a what a ruin bar was meant to be like so was quite impressed by the way it was decorated when we first walked in. Walls were just sticker-bombed with various designs and each room had a unique theme. 

13.02.19 - Budapest

Baths -

14.02.19 - Budapest

Valentine’s Breakfast - Woke up earlier than everyone else (which was like 10 am) to 

Mak Bistro for lunch -

Buda

15.02.19 - Belgrade

Bus from Budapest to Belgrade - fairly comfortable, was watching Vox and Vice documentaries the entire trip. Crossing the border was rather a long process in itself. 

Dinner at Sarajevski - Ordered 6 main dishes of protein (chicken, sausages, mince patties), a tomato salad and wedges as well as beer and all of that only cost us less than $10 per person. It was a feast and a welcome one after the bus ride.

16.02.19 - Belgrade

Walked around Belgrade - Quite a bleak and run down city. It reflects the Soviet rule and constant bombing attacks. We think we were followed by two men for a while but then we confronted them and the disappeared. Don’t know what was up with that. The long pedestrian strip in Belgrade was a little more lively and had a lot of children playing instruments. Also watched some old mates playing chess at the park.

Dinner at Walter - I love kajmak. The dinner tonight was so good. The kajmak had melted over the chicken and the bread was the perfect vessel to carry the sauce of kajmak and chicken fat into my mouth. It was truly glorious.

[seekingvalueinlife]

Rome for the Weekend

Time New Roman

‘All roads lead to Rome’ and so somehow on my elective in Malta by some kind of fate I found myself with a backpack of clothes on a budget flight to Rome.

As a city that has been around since 500 BCE, far longer than the country of Italy itself, there is so much history, culture and art that personifies Rome and makes it feel as though it is itself living and breathing. 

To say the city is grand would be an understatement and with so many towering obelisks, columns of Egyptian granite and the marble statues of many artistic greats that you almost take for granted the amount of time, labour, skill and craftsmanship to bring about these amazing architectural feats. Then you remember that Rome was not just the capital of one of the largest empires of the Western civilisation but also the centre of the Catholic Church and so you start to understand the extravagance that plagues the city.

However, the Rome that I saw was not the same Rome that Caesar saw or the same one that Pope Alexandar VI. Rome has restructured with the rise and fall of governments and Popes. Entire sections of the city have been physically raised, buildings have been modified or religiously converted, the parts of a building could be used in a palace for hundreds of years before being pulled out to be placed in a new church. So despite the age of Rome, there seems to be no limit to Rome’s changing face. 

I cannot say I know much about art but I can really appreciate the accurate depictions that Renaissance art has for the human body. The size of the works in the Vatican was unimaginable and the ways of using large paintings to give a room so much depth and meaning was just on a whole next level. Can we just admire Michaelangelo for a second. He makes men look like gods and makes God look worthy of following. 

Italian cuisine

Pasta. Pizza. Gelato. 

The three staples of my weekend. If there’s something the Italians have figured out it’s knowing that when you do a handful of simple foods you cannot go wrong. My highlights:

Coffee & croissants - The best starts to the morning. 

Cacio de Pepe - When you make fresh pasta and cook it al dente you don’t need much more than olive oil, black pepper and some parmesan to make it a delicious meal. 

Cream-flavoured gelato - Gelato is already creamier than normal ice-cream and having gelato with no other flavours added helps you appreciate the quality of the gelato itself. My next favourite flavour would definitely be the espresso/coffee flavoured ones I tasted.

Eggnog cream - I already miss this just thinking about it. Move over ice-cream with a cherry on top, it should be gelato with eggnog cream on top!

That won’t be the last I see of Rome.

[seekingvalueinlife]

Malta

I know next to nothing about architecture but I’ll pretend here because the architecture in Malta is so diverse that I find it hard not to write about it.

Off-white and sandstone concrete and brick apartments surround our Airbnb in the suburb of Il-Gzira, probably owing to Mediterranean influences. These buildings only exist as straight block lines and buildings with any splashes of colour almost look out of place. It feels simply yet humbling and when it isn’t raining and you can look from one building to the next to see laundry on rooftops fluttering in the wind, you can really appreciate the beauty in it all. 

Any colour feels almost out of place.

Taking a stroll down to Sliema when the weather is good, you can see that the harbourside takes on a more contemporary feel with the tall modern hotels and apartments being dominated by their large glass panels and metal counterparts. The many leisure cruises and large yachts that float empty on the harbour or docked at the pontoon suggest Sliema has changed to accommodate the thousands of tourists that come to Malta in the warmer months for its beautiful beaches and azure ocean rather than its heritage housing.

New contemporary buildings in construction to accommodate the influx of tourists that frequent Malta’s natural resources.

It is only a short ferry ride across the water from Sliema to Valletta but the Baroquesque buildings in Valletta greatly juxtapose those of Sliema. While Sliema’s modern apartments tower over the water the houses in Valetta still hold their place as the intricate and ornamental architecture takes on its own form of grandiosity and exuberance. Here you will find curved lines, most obvious is the dome that fills the skyline (Basilica of Our Lady of Mount Carmel), or the arched windows and doorways. 

Definitely a sense of grandiosity. 

Arched doorways and windows can be seen in Valletta.

[seekingvalueinlife]

The Northern Circuit Safari: Day 1

The ‘Northern Circuit’ of Tanzania consists of several national parks and conservation areas that are core to any safari in Northern Tanzania. It includes the world-famous Serengeti National Park, the Ngorongoro Crater as well as lesser-known parks that surround them including Tarangire National Park and Lake Manyara. 

Map of the Northern Circuit (Taken from Tanzania Odyssey - www.tanzaniaodyssey.com) 

I was on a medical elective with 4 other students from a university in Australia and we had booked a 4-day/3-night safari that included visits to Tarangire National Park (Day 1), Serengeti National Park (Day 2-3), Ngorongoro Crater (Day 4). 

Waking up at 5:00 a.m. with our bags packed from the night before, we felt more excited than tired as we got ready for our scheduled 5:30 a.m. pick-up. It was still dark when the 4x4 Landcruiser pulled up at our house in the Doctor’s Compound of Kilimanjaro Christian Medical Centre (KCMC). Out from the driver’s seat popped David who would be our driver-guide for the next 4 days and as he loaded up our bags in the back, we piled into the window seats that occupied the main compartment of the Landcruiser.

Travelling so early in the morning, the road between Moshi and Arusha was quite empty.

By 5:45 a.m. we were on the road bound for Arusha. The trip would take us just under 3 hours and would give us our first clear view of Mt. Kilimanjaro since we had landed. Having lived at the base of Mt. Kilimanjaro for the past 2 weeks we were convinced that it would remain shrouded behind the thick clouds that constantly kept it from our view. But as the sun rose behind us as we sped towards Arusha, the tallest mountain on the African continent filled the horizon in all its glory.

Mt. Kilimanjaro, the tallest peak on the African continent, no longer concealed by clouds!

The town of Arusha was very similar to Moshi except that by 8:30 a.m. when we rolled in the pick up our 6th member of the group safari there were hundreds of modified vans turned buses darting along the dirt roads.

Like most souvenir stores that are included on a tour, this one was a trap with tiny wooden sculptures being sold for 60 USD and mass-produced (Made in China?) beaded bracelets at 5 USD. We stayed only long enough for David to finish his coffee.

Tarangire National Park was one of the smaller parks that we visited but it was a great way to ease us into the safari. It had a large network of interconnecting roads. This meant that it was possible to drive up close and personal to many of the animals found within the park. The only problem was that the changing topography of Tarangire and the density of its trees restricted potential animal spotting. This was only an issue because admittedly I had the preconception that a safari would be spotting animals on the flat uninhibited savannah from Pride Rock (blame the Lion King).

The undulating terrain and the dense bush meant that we couldn’t see too far into the distance but that didn’t stop us from spotting an abundance of wildlife!

The animals that we observed just metres from our Landcruiser included elephants, giraffes, lions, cheetahs, zebras, warthogs (Pumba!) and various antelope and birds. No doubt we left Tarangire that afternoon content with the number of animals we had spotted.

Oh! Tempo Mkubwa! (Oh! A Big Elephant!) 

Zebras look in different directions to detect prey from all angles. 

The photo doesn’t show it but this cheetah was extremely difficult to spot.

With game drives in the park on either side of lunch, we had our lunch break at a designated picnic area overlooking the river. 

Lunch with a view!

Little did we know that around the picnic area were these sneaky little monkeys that had obviously taken a liking to human food and would quite literally risk it for the biscuit. So when I sat down, oblivious to the tenacity of these primates it didn’t take more than 20 seconds for them to have their pesky fingers around a pack of my peanuts. Anyone who knows me knows that I love my peanuts and you’d think that I would learn after losing an entire packet. However, before the end of lunch, I had lost another bread roll to these monkeys, this time they were game enough to grab it straight from the lunch box I was protecting dearly with my hands.

There aren’t any apple trees in the Tarangire but there are plenty of lunch boxes. 

Seems like there’s a couple of mouths to feed.

That night we stayed at the Sunbright Lodge in Mto Wa Mbawa. Most basic budget safari’s stay in one of many lodges in Mto Wa Mbawa (between Tarangire & Ngorongoro Crater) on the first night as opposed to more expensive lodges in the game parks that incur a premium fee. The lodge we stayed at had beds set-up in somewhat permanent tents and to our delight working hot showers. 

This is what a mean by a somewhat permanent tent. 

At the lodge, we also met our cook, Nora, who would accompany us for the rest of the trip. Most safari packages are catered towards Westerners and every meal reflected that. After eating Tanzanian food for the last two weeks (Tanzania isn’t exactly known for its food), it was oddly satisfying to eat a Western meal with Western portion sizes, albeit cooked by Tanzanian hands and with a little bit of Tanzanian flair. We learnt to play ‘Durak’ from our new friend over some ‘Safari’ and ‘Kilimanjaro’ beers (provided with dinner!) before calling it a night.

[seekingvalueinlife]

A Tanzanian Safari on a Student Budget

One of the main draws for doing an elective in Tanzania was being able to discover the natural beauty of Africa and the diverse flora and fauna that inhabits it. The documentaries I had watched on National Geographic as a kid had imparted in me that no true experience of Africa would be complete without seeing a pride of lions sink their teeth into a straggling gazelle as the shimmering sunsets over the savannah. Disney’s Lion King was also unashamedly my favourite animated movie and so it was almost a no-brainer that a safari was on my bucket list for my trip to Tanzania.

Tracking and spotting camouflaged wildlife is all part of the safari experience.

However, as I soon discovered a Tanzanian safari is not exactly something that can be done on a tight budget. If you do some reading you might find that with enough time and research you can plan your safari by directly organising your own, car and driver-guide when in the area, paying for your own game park fees, organising camping equipment, planning and preparing every meal while on the move all while figuring out where to find where all the animals are. This may slightly reduce the price of the safari but in our minds, there were too many variables coming into this. With limited experience in organising extended overland trips in a foreign country, we decided the best option was to book a safari through a local Tanzanian tour operator and save our money by reducing any third-party costs. This would ensure that we could enjoy our safari and focus on the long game drives without stressing about logistical problems.

A quick google search of “Tanzania Safari” will reveal hundreds of tour companies that advertise various safari packages that range from basic group packages with overnight camping to luxurious private packages that include a bottle of champagne with every meal and stay at the Four Seasons in the Serengeti. This is because for many a safari is a glamourous getaway that you can easily book from a reputable transnational travel agency all from the comfort of your own home. For us, as a group of young medical students, our main income source came from the odd hours of tutoring each week (and who can forget the generous Youth Allowance from the Australian Government). Admittedly our budget was a little more than the backpack traveler 270 days away from home. However, we knew that if we wanted a sufficiently long safari of the Northern Circuit that would satisfy our wildlife-cravings then forgoing any added luxuries (our dreams of sipping Moët from a hot air balloon over the Serengeti slipping away) and booking with a local Tanzanian operator would be the way to go.

Serengeti means Endless Plains but there was definitely nothing plain about it.

Our 4-day/3-night safari of Tanzania’s Northern Circuit in December 2018 was 640 USD per person (+ extra 20 USD per person for tips). This was for what you could call an all-inclusive safari package at the most basic level (camping safari accommodation, game park entry fees, driver-guide, 4x4 Landcruiser with unlimited fuel, cook/chef, nutritious meals with an assortment of beverages, pick-up & drop-off from Moshi and 2 beers per person per night!). We believe that this would be close to the minimum if not the minimum that one could book a basic Northern Circuit safari package.

A 4x4 Landcruiser with a pop-up top is a must for optimal viewing potential

At over 160 USD per day you can see how a safari can quickly consume through your travel budget. However it’s important to note that over the 4-days we did not have to spend an extra dollar Tanzanian shilling on anything else and need I say that we were well-housed tented, well nourished and well wildlife-ed out by the end of it.

So how did we manage to reduce the price of our safari?

In short:

Booked through a local tour operator based in Moshi

Booked as a group of 5 people

Booked as a group safari (as opposed to a private safari)

As a student undertaking a medical elective at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania the main advantage was being able to meet with local tour operators after arriving in Tanzania. There are many local tour operators that are owned by Tanzanian locals and these generally offered lower prices for similar packages when compared to international travel agencies (they don’t have to pay for marketing, international representatives etc.). While international operators may have a better online presence with more reviews, it’s debatable whether they offer anything of added benefit besides a reliable reputation which may obviously help provide peace of mind for someone booking from another continent.

In fact, we discussed our experiences with other students staying at KCMC who had booked similar packages through other international agencies and our experiences were pretty much the same (same itinerary, same vehicle, same parks and routes, same accommodation, same food).

We booked as a group of 5 and contacted various offices in Moshi via email for their itinerary, inclusions and pricing. We literally found these operators by typing “Safari Moshi” on Google Maps and contacting every single one that came up (the same can probably be done for Arusha). We short-listed several operators based on the aforementioned criteria as well as reviews from TripAdvisor, Google & Facebook.

A quick search in Google Maps reveals all the companies with local offices in Moshi, the same can be done for Arusha.

We then met with the managers of these companies in-person at their offices mainly to confirm all the details and to settle any doubts about their legitimacy. However, if you’re booking from outside Tanzania and flying in for a safari then meeting up with these operators is probably not possible. I think that while having an in-person meeting did add some peace of mind it wasn’t particularly necessary especially with companies with sufficient raving reviews. As I mentioned before the local company (Joining Safaris) we ended up going with offered and delivered on everything that we had asked. The landscapes were breathtaking, the game drives were exciting, the food was nourishing and the camping much more comfortable then expected (even when it rained for two nights!).

There was one thing that we had to fault though and that was the limited information that the driver-guide would voluntarily impart on us. On these safaris, the driver usually double-ups as the guide. Although our driver-guide was quite knowledgeable and able to spot and recognise animals that we had trouble seeing with our binoculars and zoom lenses he would only relay information when asked directly and kept to himself most of the time. He did manage to track down the Big 5 and we were thrilled when he rushed to secure prime viewing of a quite intense scene involving a pride of lions, a zebra carcass and some jackals. However, a more interactive and engaging guide may have made the experience more educational and enjoyable. From observations of fellow safari-goers, the proactive guides were often involved in the higher-grade packages and their enthusiasm would demand a premium tip.

One of the most intense scenes of our safari in the Ngorogoro Crater - A lion pulling a zebra’s head from its remaining carcass.

Alas other students from KCMC who had paid for a similar basic safari through a more expensive international agency before they arrived in Tanzania reported similar issues with their guide. So it seems that if you value an informative experience then a basic safari package won’t be sufficient for you. However, if you want to witness the magnificence of the African landscape and the animals that thrive in this intricate ecosystem while on a student budget then I guess a little bit of compromise and research is going to be well worth it.

A young male lion sits metres away from our jeep in the Serengeti.