wow fast internet

Just thinking how even though I'm home in NJ now, and the internet is super fast, I don't really feel like using it. Also been thinking about how lucky I am to live in Kenya. I wanted to find some pictures to convince you of that, but it's hard to express in pictures I guess. Come visit! I'll be back there Jan 8.


Those are impala on the side of the path.


Crater Lake, Naivasha.

Life on a Sugar Plantation

As you may recall from my last post, this past week has been incredibly busy as everything that needs to get done before the end of the year pretty much fails to get done. We successfully received our VIP visitors although we don't know yet how much they want to collaborate with us. On Friday CDC/KEMRI had a big retreat with enforced fun for all of the staff, including such amazing activities as an eating contest and trust falls. We (Darryn, Jo, Steph and I) escaped a bit early from the big day for our own personal working/writing retreat at a farmhouse about an hour outside of Kisumu. As you can see, it was both relaxing and productive, if you pretend that I could see my laptop screen while sitting in the 90 degree sun.

But honestly we did get a lot of work done, and went on a couple of horseback rides around the amazingly green landscape that is the sugar plantation. Actually it's not JUST a sugar plantation, they grow coffee, raise cows and make cheese, breed horses (they have 65) and run a guesthouse. Oh, those Kenyan Cowboys really know how to live the life! A few other visitors (two vets and a veterinary immunologist) came and joined us for the second night, bringing along a 12 year old Australian Cattle Dog that has lived on 4 continents. We had a lot of good talk about zoonotic disease surveillance etc leaving Steph to hopefully make progress on her solely human related work. The immunologist did her PhD and a postdoc at UCDavis before coming here. Honestly I meet more people with Davis connections than seems at all possible.

On the way back home this afternoon, we stopped at Tilapia Beach for lunch. This is the view over the "lake" aka invasive water hyacinth field... it drifts around disconcertingly and is sort of nauseating to watch because you don't really expect what looks like green land to be moving.

Tomorrow we have the day off for Kenyan Independence Day (actually today 12/12), Tuesday I'm going to the field to officially end the pilot stage of the surveillance project so that we can start afresh in January with a system that hopefully will work consistently, and Wednesday I fly to Nairobi for important work meetings with the important visitors from last week, then don't bother coming back to Kisumu before flying back to NJ on the 22nd! Wowee.

OH GEEZ

So…yeah, BUSY BUSY BUSY basically. That's all. I am taking time out of my packed schedule to write this because it seems like relevant procrastination.

So I was in Nairobi the past couple of days, so that I could meet with the head of epidemiology at the Department of Veterinary Services. I even briefly met the Director of Veterinary Services for Kenya, and he told us stories about the good ol' days when Veterinary Officers in remote districts could pretend to be doing work when they weren't. It probably seems like the meeting was a really big deal, and it was sort of, but I went with two of the Kenyan vets that I work with, and basically they are all buddies because there is only one vet school in Kenya and every vet therefore knows every other vet and all of his or her business (77 newly minted vets graduated last year, and apparently that is a huge class). Anyway, they weren't as excited about immediately implementing my mobile technology disease surveillance in every district as I would have hoped, but they did want to make sure that the information we collect gets to the local Veterinary Officer, possibly monthly, which sort of defeats the purpose of real time reporting but ANYWAY we'll see what actually happens. They are, on the other hand, piloting digital pen technology for notifiable diseases as well as mobile phone reporting for "zero reports" where they do active surveillance to make sure that certain diseases (like Rinderpest, which was recently eradicated) is actually not there. The mobile phone based syndromic surveillance that we are doing with ADSARS would do a third and separate thing, which is allow for timely surveillance of not-necessarily-notifiable diseases as well as emerging diseases.

I also had the opportunity to observe arthopod collection in the slum of Kibera, which basically involved following around a guy with a ghostbusters-type backpack vacuum cleaner mosquito catcher through the narrow streets and open sewers and into people's homes. The demographic surveillance they are doing in Kibera is equivalent to the study in the rural area near Kisumu, except it is about as urban as you can get. The part of Kibera that we were in is predominantly Luo, so they speak Dholuo, which is just like being in the field out here so it was quite an interesting contrast. The houses we went into were filled with a lot more stuff than I had imagined would be the case, but it made me realize that the difference between rural poverty and slum poverty, in a certain sense, is that by moving to a slum you have the potential for electricity sometimes, and to own a TV and furniture with cushions, and have a water tap nearby, and what you give up is a relatively clean environment and the ability to grow food to eat. Obviously that is a simplistic description of a very complex social phenomenon but it expresses my first impression, I guess.

But the primary reason that I am so busy, besides everyone freaking out about getting stuff done by the end of the year, is that we have some very important visitors next week and I have to do a presentation on ADSARS to try to convince them to collaborate with us. While in Nairobi, I also got to meet with our newly appointed head of Zoonoses at CDC Kenya (previously lab director), and he is awesome, and he loves ADSARS, and he has a ton of suggestions and can convince the lab people that this is a priority so that maybe we can actually get some lab tests to happen…and also next week when he's in Kisumu will find time to talk to me about my life plans and potentially making things happen in order for me to not just abandon this project while it's just getting going. So we'll see! But anyway, in addition to the important people, I'm supposed to be in Bondo for the third and final stage of the participatory epidemiology study Sunday through Thursday, plus Darryn and his ex-boss Sarah will be around and I'm submitting abstracts/papers for conferences, and writing about ADSARS for CDC's Global Disease Detection yearly newsletter by Monday! I'm also going to travel back to Nairobi with the whole group of visitors December 14 - 17 which is practically tomorrow, and then it probably wouldn't make sense for me to come back to Kisumu just for the weekend before flying to the US on December 22 so basically that means I'm leaving practically tomorrow. DOES TIME EVEN MAKE SENSE?

But it is just as important for me to mention that I ate Lebanese food in Nairobi and it was basically the best EVER EVER EVER and I ate at least 4 platefuls and then had leftovers for breakfast and why can't Kenyan food be more like Lebanese food?

Kenyan Thanksgiving

As you may know, one of my favorite recipes ever is Potato and Kale Enchiladas from Veganomicon, which I'm excited to say I was successfully able to make (Kenyan fusion style) for Thanksgiving Potluck Part 2. I'm even more excited to be eating the leftovers for breakfast right now, along with Silk soy milk that a friend bestowed on me after her parents brought it all the way from Pennsylvania, and pistachios roasted with salt and lemon. Kenyan fusion style means cassava instead of potato, sukuma wiki instead of kale, cashews instead of pumpkin seeds, and a friend's homemade tortillas/chapattis. The non-Kenyan part is the delicious spiciness and lack of cornmeal. I bought the cassava when I was out in the field the other day, and for $.75 got probably 5 kg of awesome fresh cassava, so also had to find another cassava recipe, and although I thought long and hard about making this, and following carefully the directions at the end:

• 25 After eating, wash your hands and take your plates to wash
  
• 26 After washing, keep them in the safe place and rest for some minutes in order to allow your food function well into your body.Here you may call it a day
  

I decided that garlic and lime (all small sour citrus fruits are called lemon here, actually, regardless of how dark green they are) would be the best ever, because honestly why isn't everything garlic and lime flavored, and made this one.

All the food brought by everyone else was obviously delicious too, although I didn't try the locally raised turkey, which apparently costs way more than chicken because people around here don't really eat turkeys so much as use them as guard dogs. But the adventure of the day was jackfruit. Every morning, Steph and Jo and I sit and wait for the shuttle to Kisian under a jackfruit tree, and wonder what tragedy would occur if the fruit fell off the tree. We finally got up the nerve to ask the staff at the hotel whether we could have one, and they were nice enough to give us one for free (no one here eats them, although you can see them for sale in Uganda). We called it a baby and carried it around, letting it stink up the car while we ran some errands, and later on Ricky showed us how to prepare it. The slimy stickiness got everywhere and we made some of the fruit into smoothies but overall were unable to handle the sickly sweetness, but we did have fun shooting the seeds at each other. If it had been an unripe one, I would have tried this recipe...

Our jackfruit baby/small child

As for real Thanksgiving (on Thursday), I worked all day which was very eventful, since everyone goes on leave pretty early in December and therefore freaks out at the end of November about all the things that need to be done by the end of the year, for example transitioning the entire Human Morbidity Survey from PDAs to smartphones in 4 weeks… Also apparently in the Nairobi KEMRI/CDC office they take off both Kenyan and American holidays but here we only get Kenyan ones. Then I attended a potluck with lots of high ranking CDC and Walter Reed people, and the cultural differences between civilian and army health research organizations was glaringly obvious, so John the statistician decided that his next job should be writing an awkward style sitcom about CDC and Walter Reed employees in Kisumu. I'll let you know when it comes out.

World Rabies Day!

On Saturday I helped out with the World Rabies Day dog vaccination campaign - this was supposed to be held on September 28^th, but for various reasons was postponed. It was hectic, and crazy, and although my initial role was to ride around and visit the 9 vaccination sites and help out with coordination, at one particular site I got pulled into writing vaccination certificates. Obviously this was the best role for the Mzungu that speaks very minimal Luo, and I'm sure I ended up asking "Your name is dog?" over and over again. Oh well.

The important lesson to be learned from all of this is that people here give their dogs ridiculous names. The most common name seemed to be Michelle, with a Barack or two and a few Obamas. Second most common set of names included Annan and Mugabe, and there was also a good contingent of Osamas and Saddams. My favorite was Tuktuk. Naming a dog after a rattly motor rickshaw taxi seems like a great idea to me.

Okay so here are some pictures of puppies.

More can be found here:

2010-11-20 World Rabies Day

Cool Conferences

Kampala was awesome, but it does feel nice to be back at home in Kenya where I know my way around... The conference was basically amazing because I made friends with a ton of cool people and learned about all sorts of awesome technologies. The proceedings are at m4d.humanit.org if you are interested in the kinds of things the conference was about. The city of Kampala is also basically amazing, because it is super green and has a lot of really old and tall trees which means there are a ton of birds, and because it’s built on a bunch of hills the birds basically fly at the level of windows on the buildings even when the buildings aren’t that tall. There was also a group of migratory fruit bats which were huge and awesome and distracting.

Saturday I stopped in Jinja, which has a crazy beach town vibe, and got to visit the source of the Nile (the point where they decided that Lake Victoria becomes narrow enough to be called a river…it used to be a waterfall but then they built several dams.) On the way back, we got held up at the border for an hour or more because the police were interrogating people on my bus because of some con involving a money changer. Never really got the details.

Of course, while I was away the guy in charge of the really incredibly frustrating lab software, Freezerworks, didn’t get anything done (for my project at least), so today involved sitting with him for about 2 hours while he set up the stuff that was supposed to happen in September but that has been delayed by just about every problem imaginable. Then the program crashed…sooo we’ll try to finish it tomorrow.

Also while I was away someone apparently started making a decision about transitioning a particular project from using PDAs for data collection to using smartphones! Basically there are a bunch of projects that talk about their intentions to do this but it seemed like nothing was going to happen before the middle of next year. Also, despite the fact that we have a mobile technology working group here, the decision makers for the projects tend to not participate in those groups and so no one knows what stage any other group is at in terms of the transition. Since I’ve been thinking about mobile technology a ton, I decided to call a meeting to get everyone to update each other on the projects so that if possible people can use compatible technology and share expertise and resources.

Okay…just got back from above meeting and due to drug company pressure for monitoring a vaccine trial they have to have the whole thing set up in six weeks, including procurement, which alone normally takes several months, so for a ton of different easiness reasons they are going to use Windows Mobile. Android still makes sense for me so sadly I will be losing some immediate collaborators that would have helped speed things along. OH WELL. Gonna make it happen anyway.

EDIT: I forgot to mention that the plumbing stopped working in my office building (aka the main science building of the public health organizations of Kenya and the US here in Kisumu) so yesterday we were supposedly not allowed to use the bathroom, but today it just has a sign that says "please use responsibly" on it. INCONVENIENT.

Now for some pictures!

The source of the Nile!

Options to choose from...

A giant spider. The little brown spec on the left of the big spider is a normal sized spider. For comparison.

Traditional multiplayer xylophones! Just like I learned about in Music of Africa!

The awesome bats in Kampala (Just realized that bats in Uganda carry Marburg virus. That sucks.)!!!

Boda Boda

Today I am in Uganda! Uganda is so close to Kisumu that it's hard to believe that I am in an entirely different country. I traveled by bus, in "royal" class which means the bus only has 33 giant seats, but there were only about 7 people on it anyway. Luckily didn't miss the bus despite the greatest efforts of the people at the bus station, who kept telling me to wait, don't board yet, they would announce it, etc. However, I was paying attention and so noticed that the bus was about to pull away even though no one had made any type of announcement. We got to the border crossing in Busia after 2 sleepy hours, where I got off the bus, got stamped out of the country, paid $50 to get into Uganda, turned down a marriage proposal, and got back on the bus. They promptly put the big "royal" TV to use and so I got to enjoy one of the great American Christmas classic movies, Home Alone, immediately followed by the other great American Christmas classic, Home Alone 2: Lost in New York. Four hours later we arrived in Kampala, just as it was getting dark. I asked the bus ticket seller guy how much I should pay for a taxi to my hotel, but then the low side of his range turned out to be the taxi driver's first offer. I was too surprised to negotiate, but whatever, it was less than $5, and we had to sit in traffic for a while to get to the hotel.

Now that I have bored you with excruciating details about my bus ride, I will offer some first-impression observations about the differences between Kenya and Uganda.

1. The roads in Uganda are way better than the roads in Kenya. A politician on the radio was talking about fixing the potholes in Kampala, but honestly we drove over one pothole on the way to Kampala, whereas the roads in Kenya are generally more pothole than road.
   
2. Uganda is cleaner than Kenya. The same politician was talking about how he set up a trash collection system in the district he's in charge of. Novel idea. Other than having fewer piles of trash on the side of the road, even all of the dirt looked swept smooth.
   
3. Uganda has a lot more trees than Kenya. I saw lots of big trees, native trees, jackfruit trees, crazy trees with giant hanging pods, and very few eucalyptus trees. I did, however, see water hyacinth in the Nile, so they are obviously not winning all the wars against invasive species.
   
4. Uganda has a lot more inflation than Kenya. Seriously, why keep all the extra zeroes on the bills? Maybe because it makes it hard for us tourists to differentiate between notes that say 5000 and 50000 at first glance.
   
5. Uganda has way different food from Kenya. I'm staying at a hotel which claims to also be a Greek restaurant, but the dinner buffet (15,000 shillings) was definitely Ugandan food – the waiter very enthusiastically recommended the matoke (mashed banana – in Kenya you can get matoke but it's never mashed) and peanut sauce (not as delicious as I expected, but still good, and it was nice to think that it's similar to what Doug is eating every day way over in West Africa) and there were of course a variety of other carbohydrate sources plus beans and cabbage (and meat).
   
6. The color that MTN paints buildings is ugly (drab yellowish) compared to the bright green of Safaricom. Luckily Zain (bright pink) and Orange (orange) are both in Uganda as well as Kenya.
   

Further contemplations about whether these differences are actually true and why that is the case (Less corruption? The tyrannical rule of Idi Amin?) are possibly still to come.

 

Update Time

As I settle into my life here, day to day events seem less worthy of telling everyone about. But I don't want to get in the habit of not posting about awesome things just because doing awesome things is second nature!

In the past couple of weeks, I have had the opportunity to participate in a ton of sweet social events, from (pre)Diwali celebrations to homemade pizza parties to ridiculous Halloween adventures. I also returned to Bondo for phase two of the participatory epidemiology study, where we learned a lot more about people's perceptions of zoonotic causes of diarrhea in children, and tried to brainstorm ways of preventing transmission with the communities. Next time, we'll see whether they were able to implement any of these preventive suggestions and see what the barriers to implementation of preventive measures are. The suggestions include sweeping the animal dung out of the compound every day, washing hands after handling dogs and other animals, preventing babies from eating dung off of the ground, boiling water and milk before drinking it, etc.

Tonight is the real Diwali celebration, with fireworks and food stalls at the Yacht (pronounced "Yatcht") Club. Luckily the Indian community in Kisumu is letting everyone participate, and I am really excited to eat delicious Indian food!

My project is going well, although setting up the lab for the diagnostic tests has been a total nightmare. Yesterday I was optimistic because the lab sample tracking software was working after being down on and off for about 6 weeks, and because the lab manager is back from vacation so I can finally get things rolling. HOWEVER I was just informed that the system is down again! This is especially bad because I won't be in the office at all next week and so far the only way progress has been made in setting up the software is when I sit directly next to the data manager while he works on it.

Next week I'm going to Kampala, Uganda for a conference on M4D (mobile technology "4" development) where hopefully I will meet a lot of people that are successfully using the software programs that I am currently struggling to implement. (Did I say my project is going well? It actually is, for example I'm starting to work with people from the Department of Veterinary Services to find out their priorities for disease surveillance, and I'm trying to come up with a paper to submit to the International Conference on Animal Health Surveillance in France in May...the software challenges are what I end up complaining about, but except for the incredibly frustrating Freezerworks, I really enjoy troubleshooting and I'm excited to see how what I learn next week at the conference will help!)

THEN on the weekend I am going whitewater rafting on the Nile with a few friends that will meet me in Jinja. I am sort of terrified but I have heard from at least 6 people that it is amazingly fun. We'll see if we end up chickening out and only doing Grade 3 rather than Grade 5 rapids. I also found out that it's possible to go on a 6 day horseback safari in the same area (along the Nile in Uganda) which includes one day of rafting, plus swimming with the horse in a "sandy bottomed pool" (in the river, great way to get Schistosomiasis, but…it's treatable…) and riding through forests full of monkeys and exotic birds! I would love to do that when I have an extra couple thousand dollars lying around…who wants to join me?

 

COOL

Some people found a medieval mass grave in Germany and used PCR to isolate Yersinia pestis (plague) DNA! Crazy! Extremely delayed autopsy!

Also cool is that today I managed to actually get some test data collection forms running on my test Android phone! And I met some guys from the Task Force for Global Health in Atlanta that are also using Android-based data collection tools (for a schistosomiasis study)! Luck!

Further updates soon, but my primary feeling right now is that time is flying way too fast and I'm having trouble keeping up.

Rinderpest and HIV and Rabies (Oh my!)

Good news – Rinderpest has been eradicated! Bad news – there are still a ton of really devastating infectious diseases out there (and right here), and many of them are not likely to ever be eliminated.

I'm currently reading Paul Farmer's book Infections and Inequalities: The Modern Plagues which, in combination with conversations about some friends' research on HIV, has really gotten me thinking about what's going on here in Kisumu and the rest of Nyanza province. In this part of Kenya, the HIV prevalence is the highest in all of Kenya – despite CDC/KEMRI and an enormous number of HIV-focused NGO's working in the area. There are various estimates of just how widespread it is, but all of them indicate that the answer is "very"… a friend's poster I read recently says 25% of women and 18% of men are infected, and another study conducted in 2003-2004 in the district where I work found that 36.5% of women aged 25-29 and 41.1% of men aged 30-34 were seropositive. The other night, as a birthday party I was at was winding down, a couple of drunk HIV researchers brought up their work. One woman is studying the impact of coital injuries on transmission, and she indicated that there are a number of cultural practices that significantly increase this risk, but the primary risk for women, as Paul Farmer also discusses, is being poor and therefore having very limited sexual agency. Back to cultural practices, though, because other friends of mine are assessing the acceptability of male circumcision in this area where traditionally circumcision has not been practiced (male circumcision has been shown to reduce the risk of transmission of HIV). The majority of people here are from the Luo tribe, who not only don't traditionally circumcise, but have a number of other traditional practices that really don't help slow transmission. According to my friend, many Luos engage in concurrent relationships, which basically means that any "ex" isn't ever actually ex. I also keep hearing about the importance of sex in funeral rites, although I haven't ever been able to get a clear picture, and this article is not available for free. ( Does someone with library access want to send it to me?) My very basic understanding is that recent widows have to be "cleansed" by having sex, and widows are also inherited by their deceased husband's brother. You can imagine that when a man dies of AIDS and his presumably also HIV+ wife is forced to take another husband this can contribute to the spread of HIV. I just found another article which includes all of this stuff, please read here.

Okay, now some optimistic news – my supervisor's supervisor, Sarah Cleaveland, has devoted her career to eliminating canine rabies and the human rabies cases that result from it. It will be a very long time until the Wikipedia page for Rabies says "was an infectious viral disease" [can you imagine how gleefully that edit was made??] but Sarah has shown that it is possible to eliminate canine rabies and that a lot more attention and resources should be directed towards this task – currently there are about 55,000 human rabies deaths each year, with almost all caused by bites from rabid dogs, and of course, the vast majority are in Africa and Asia. I haven't done the calculation myself but according to Jo H. that means someone dies from rabies every 8 minutes. Sarah also played a large part in the founding of World Rabies Day, and here in Kisumu we are doing our part in extending it to last all year (it was supposed to happen in late September) because our shipment of rabies vaccines has been delayed. Our mass dog vaccination campaign will probably happen this Saturday or next, and I'm super excited to be a part of it. Rabies is a disease that I find fascinating, it's a deadly generalist virus that can infect essentially any species of mammal, and the reservoir of domestic dogs with rabies has led to devastating outbreaks in lion and African wild dog populations. Thinking about the ecology of all the interactions and connections…wow. And it's vaccine preventable! Seems like a good disease to devote a career to. But there are so many other neglected diseases…good thing no one is forcing me to pick one disease to study!

 

 

The pictures you have all been waiting for

So I'm currently sitting at the Duke of Breeze Rooftop Bar (DuKe stands for Dutch Kenyans since it is run by some Dutch people, apparently they showed the World Cup final here and all the Dutch in town (which is many) turned up).

The reason I'm not at the office, besides the fact that the internet there is awful, is that this morning I had to renew my visa! That means I've been here three months. Which is ridiculous since, if you count the month or two I'll be in Scotland and other places, it means that I am a third of the way through my time in Kenya. Ahhh I'm scaring myself. But renewing the visa was thankfully painless, although I had to strike a delicate balance and make sure to emphasize that I am not working but just came here on holiday because I love Kenya. Which is pretty much true. I also had to give real ink fingerprints, and my hands are a bit stained now but presumably that won't last forever. And apparently in a month I can go back and pick up my Alien Registration acknowledgment, whatever that means.

So I decided to take this opportunity to use the fast internet and download all the programs I need to start setting up a data collection program on Android. And post a ton of pictures.

First, the house I live in:

The living room. Note the parquet floors and tasteful interior stone wall.

My backyard (there is a very noisy construction site on the other side of the wall).

The view of the sunset from my porch.

The view from the top of Mount Kisian (aka the hill near the CDC/KEMRI HQ)

A newborn calf reported and responded to.

Participants in our Participatory Epidemiology interviews participating by deciding how to divide buttons to indicate the causes of certain types of diarrhea.

My job as recorder mostly involved counting buttons and reminding the translator to tell me what was going on.

On Ndere Island, there are a ton of swallows.

Jo, Steph and Per walking ahead of me on the island.

This calf was the last one recruited to the IDEAL study that I talked about a few weeks ago. They get sampled every 5 weeks from birth to a year, so this calf, at the last visit, clearly knew what was in store for it.

What was in store for it involved being measured with a giant ruler. By the way, this calf, according to genetic markers, is 100% native African cattle with no European blood. They used it as a really prime example of why you can't tell the breed just by looking at color.

This is the view of the Kisumu skyline from the lake. The one relatively tall building that stands out is a 30 floor (ish) monstrosity that was built as the provincial headquarters. That's where I went to get my visa renewed this morning. Unfortunately, the building was ahead of its time, and they may have run out of money while building it, so it sat empty for a long time. Now the bottom 6 floors are in use, but none above that because there is no elevator.

Much News

Hello! This past week helping out with the Zoonotic Enteric Disease participatory epidemiology study was GREAT! Except that the tiny hotel room I was staying in developed a puddle problem. My Luo language skills improved significantly, although unfortunately for real life mostly I now know lots of words for diseases, especially types of diarrhea. Oh well… I got to meet all sorts of cool people that do awesome public health work, and spend lots of time in rural villages where I obviously get to see cows and goats and dogs of all different colors (sheep too, but they aren't so exciting, the sheep here are really ugly). And people! Nice, welcoming people that really (for the most part) seemed to enjoy talking to us and telling us about their lives and all the types of diarrhea that their children under 5 have. One woman in particular was so enthusiastic (here they would say "keen") and always wanted to tell us what she thought or help arrange the button counters (used to indicated visually how frequently certain symptoms are seen with different diseases, for example), and then at the end of the interview she thanked us profusely for coming and made extra sure that we're really coming back to talk to them again in November (which we are). It made me really happy to see how much she (and other less expressive participants) appreciated us being there and learning from them. The only sad part is that I'm sure this particular woman would have loved to go to college, and done well, but probably didn't even get the opportunity to go to high school.

On Saturday when I got back I finally realized that I am never going to find this 8,000 shilling ($100) Android phone that I heard rumors about because they decided to sell it for 16,499 instead. So then I went and bought one, because $200 is still way not expensive for a smartphone! And now I have to figure out how to make it work perfectly for disease data collection!

Then today I went to Ndere Island National Park with Steph, Per, and Jo. It's about an hour's drive outside of Kisumu through the most beautiful/interesting area…there are a ton of rock formations and oddly balanced boulders. Anyone know how this happens? Would it have anything to do with the fact that a few geological time days ago the whole area was under The Lake? This drive and the PE study both made me want to spend more time out in the rural communities, so hopefully I'll get to actually stay out at the field site once things are up and running! At Ndere, I managed to pay the resident's rate and we took a boat out to the island and had a nice hike around for a few hours. The island is awesome, and we were literally the only people on the whole thing (it's about 4 or 5 km squared) until when we were leaving a school group arrived. We saw impala, baboons, monitor lizards, a huge crocodile in the water, a ton of birds, a bushbuck and also unfortunately a lot of invading water hyacinth. No giant snakes though.

I know I keep saying I will post pictures and I'm really gonna try now. And then I will try to post one picture each time because it has to work with just one, right?

At Ndere Island...the bright green in the bay behind me is water hyacinth.

An example of the boulders and the general landscape.

Happy Half Birthday to Me!

I'm writing this from my teensy weensy hotel room in Bondo, a small town about 50 km outside of Kisumu. I arrived here earlier this evening with a group of 12 people that will be conducting a participatory epidemiology study to determine how much local knowledge there is about zoonotic causes of childhood diarrhea. In the process, I will learn all about participatory epidemiology techniques and hopefully organize to do some semi-structured interviews of my own next week or the week after. In any case, the proof of the teensy-weensy-ness of my hotel room is in the fact that the shower head will undoubtedly dispense most of the water directly into the toilet bowl, and the tiny sink that is less than 3 feet off the ground didn't even fit in the bathroom. The part of the room that is not the bathroom is also small, though. I almost got a bigger room but it turns out the hotel manager was reading the wrong line on the spreadsheet.

To fill you in on what I've been doing for the past forever since I posted, it has mostly been 1) stressing about applications for next year, 2) ordering pretzel m&ms from Amazon.com because now that I'm not being vegan it clearly makes sense to ship chocolate halfway around the world, 3) going to the movie theater to see movies that were out in the US when I was home 3 months ago but that I didn't get to see, 4) making lists, and 5) tallying all the Compton money that I've spent so far. Turns out the perk of my new(ish) house which means I no longer have to pay for public transportation very often is far outweighed by the extra money I spend on food because I live alone but still cook as if I had several extra mouths to feed.

The other night I went to a potluck type party hosted by the director of the Walter Reed Army Institute of Research in Kenya. This party (held on the first Friday of every month) apparently inspires all the wazungu that normally hide inside their embassy security level compounds to venture outside, so I met a lot of people I had never met before. Mostly everyone else that works for Walter Reed has a southern accent, and mostly everyone that works for CDC has some kind of east coast accent, with the best one being this guy John who has a ridiculous Boston accent and sounds like JFK from Clone High, almost. I was told by two people that I "don't have an accent" which I think just means I am good at melding everyone else's accents. I have also now met two Peace Corps volunteers here, and as inconvenient as it is that Doug wasn't placed in Kenya, it seems like PC Kenya is extra screwed up and inefficient, and West Africa is probably a way better region to be in from that perspective.

In other news, my toe is healing nicely, but yesterday I narrowly avoided getting mown down by a bicycle (boda boda) and then a couple hours later tripped over the curb when the matatu I was about to get on started pulling away and I fell and ripped my jeans and skinned my knee. I think I will claim that my new(?) clumsiness is a side effect of Lariam.

I was thinking of going to Nairobi this weekend to try to track down the inexpensive Android smartphones (that supposedly exist and that I want to use for data collection), but I didn't go, for various reasons, and instead asked everyone in Kisumu that claims to work somewhere that sells phones about them and nobody knew anything about anything. Not helpful, but one of the people I talked to was nice enough to claim she'll look into it and call me back, so I may be on my way to becoming an Android developer. Once the smartphones are up and running I can hopefully stop trying to receive SMS reports in the tiny mobile network dead zone that surrounds the desktop computer in the field office, and get the project moo-ving.

I've also been learning to speak Dholuo, and yesterday had a lesson in which I learned lots of names of animals, which may be helpful in my interpretation of what we will talk about this week, but probably I still won't understand anything. I was hoping to be fluent by now, but shockingly, after two whole hour long lessons, I am not even proficient. People from the Luo tribe do not like to speak Swahili and do like to speak English, to make a broad generalization, so overall I have mostly been learning to speak Kenyan English… Me I think Kenyan English is great.

This is not a real update

Hi! I really really desperately want to post pictures from various adventures, but I don't think that will work out too well with my bandwidth restricted (THROTTLED!!) to 32 kbps.

On the bright side, I got my hair cut today!! Then I went and tried on a nice, acceptable work-wear dress, and it cost $100!!!!!!!!!! So I didn't buy it. I wouldn't even pay that much in the US for an impulse buy dress. Then on the way out of the store I stubbed my toe and noticed about 1/2 hour later that I was bleeding and presumably being infiltrated by lots of awful bacteria and parasites. So if I die soon from septicemia or cutaneous anthrax or lose my big toe to gangrene, you'll know why. Take that, dress sellers!

IDEAL (More about cows)

So there is this study going on in Busia, right on the border with Uganda, and it is called IDEAL…Infectious Diseases of East African Livestock. Basically they recruited a cohort of about 550 calves at birth, paid the owners for the right to tell them how to raise the calves, told them not to dip them or treat them or anything, and visited them every 5 weeks or whenever they get sick. This study will form the basis of the data that I will use to create a diagnostic support tool because they gathered extensive information on clinical signs and attempted to diagnose every clinical episode in the life of every calf. The disease burden here is high, 16% of the calves died, with almost 90% of those deaths from infectious causes, and 60% of the infectious causes were East Coast Fever, the disease that I did my thesis on.

So today I traveled to Busia for the workshop and party celebrating the end of the field work, and to meet the people that I'll be working/living with in Edinburgh in January. After watching a bunch of cool presentations about what they've found so far in the study, we drove at breakneck speed to the farm where the last calf lives, to collect the last set of data! Actually, we didn't drive at breakneck speed because CDC cars have "governors" that use GPS to track the car, and notice and beep anytime the car goes over 80 km/hour, so we had some trouble keeping up with the ILRI vehicles that don't have speed restrictions. It was really cool to see them collecting the samples and examining the calf, since I adapted our collection protocols from theirs. Also, it was great to be in the field again! I am desperate to finish doing office-y things and get back out in the field actually playing with cows (and other animals).

I also met a really cool guy named Mark who is the District Veterinary Officer for one of the districts near Kakamega (north of Kisumu). He is super enthusiastic and is really interested in mobile technology and setting up animal health surveillance that can be done in real time instead of what they have now which is a system of reportable diseases and paper forms that are often faked and take months to travel to the central offices. So I hope hope that this spring I can try to expand my ADSARS (everything has to have an acronym…Animal Disease Surveillance and Response System) to his district, where it will be in the hands of local government, headed by an awesome DVO!

I want to post some pictures, but I think that will have to wait until tomorrow. Sorry.

Younguns

I think it's getting to the point where things don't seem so new and exciting and therefore I don't get overcome by an urgent need to post every time I see a dead dog. So, sorry about that.

This past weekend, Isaac Holeman paid me a visit! He is super cool, and he had a Compton Mentor Fellowship last year during which time he did more than several amazing things including living in Malawi, creating a non-profit called FrontlineSMS:Medic, and winning another fellowship so that he can continue to work on this project for the next two years! This is excellent because it means that he was in Nairobi and so he could come over to Kisumu and give a presentation on FrontlineSMS:Medic for our mobile technology working group and maybe help me out with fixing the problems I'm having with FrontlineSMS and give me advice on mobile technology in general. He was, in fact, very helpful, despite not being able to actually visit my computer server at the field site because his half hour flight was delayed for four hours.

Okay also we did fun things like go on a boat ride on Lake Victoria! It was in the afternoon so the water was very choppy, indicating again that Lake Victoria is pretty much just an ocean. Although apparently Lake Superior is bigger, but is that really true? I don't know. Measuring either the surface area or the volume of a lake is basically impossible. We also visited the Impala Park, which has free ranging impala and zebras but lions, a cheetah, a hyena, and some jackals in cages. It is sad that their cages are not really big enough, but apparently they used to be even smaller. We did both of these activities with this guy named Josh who, like me, is lucky enough to have an awesome fellowship that allows him to live in Kenya for a year after graduating. He is based in Nairobi and graduated from Stanford but he also loves infectious diseases so that's cool. My friend Ricky introduced me to someone by saying that I have an "enviable enthusiasm for diseases" so basically the same is true of Josh but I don't have to be envious because I am already enthusiastic. For example, this is cool!

I also watched the movie "Sideways" this weekend, and enjoyed it, and mostly finding out that it came out way back in 2004 was shocking to me. When I mentioned that that was high school for me, everyone else was shocked and appalled and no longer wanted anything to do with someone so young. So I didn't point out that I wouldn't even have been able to get into the movie in theaters because it was rated R and I was only 16. Also I think as a defense mechanism I am almost already thinking of myself as being 24, which is really going to make my next two birthdays pretty disappointing.

Oops

Oops I'm in a bad mood… tomorrow we're giving out phones to 11 more animal health reporters, and everything was going really well, today I went to a Community Advisory Board meeting which was nice but long and only a tiny bit about my project, mostly it was about Steph's really cool project on "pharmacovigilance" and antimalarials in pregnancy. Except now FrontlineForms is challenging me once again with random technical difficulties without explanation. Now when the reports come in the messages are not being decoded into a row in the database as they are supposed to.

Don't know why I'm grumpy though, I think it's because I'm realizing it's mid-September already and everything happens so slowly!! Everything is both long and short, speeding by and also crawling. I feel like I'm not working hard enough, but there are so many different things to work on its hard to feel like I'm making progress on any one thing. Just bootstrapping.

Anyway, I assume I'll feel better shortly, as I usually do. I'd post pictures to make up for a depressing and short post but it costs too many megabytes and the internet is toooo slow. Maybe that's the real reason I'm grumpy. I want my internet back! Someone please fix the underwater internet cable.

To Hell’s Gate and Back

Hello again. Sorry for the long delay in updating. I've been busy and also used up the credit on my modem so now only have internet access at work (until I buy more credit). This means no facebook either, so don't try to reach me there.

Work is going well – we're going to be expanding our pilot run from 2 villages to 10 villages because we are still not receiving reports. Last week we confirmed that the animal health reporters aren't having trouble other than the fact that the farmers aren't reporting sick animals to them. I think more outreach directly to the farmers will be necessary – hopefully this will happen when we do our participatory epidemiology stuff in the beginning of October. Which is really soon, by the way. Not sure how that happened.

Okay but the interesting stuff to tell you about is my trip to Naivasha/Hell's Gate/Nairobi this weekend! I skipped work on Friday and traveled to Naivasha in the morning to meet up with Theresa from Mpala and a group of VSO volunteers that I got put in touch with through Ricky, an American VSO guy that works in Kisumu. It was super fun to get out of town and meet new people and be outside! We went on a boat ride on Lake Naivasha and saw some hippos and pelicans and a fish eagle. The next day we rented bikes and rode to Hell's Gate National Park which is basically the only park where you are allowed to walk or bike…there are no lions, probably, and apparently the buffalo aren't a problem. It was awesome to just be biking along (even though the bikes were a bit uncomfortable). The road was fairly flat and there were lots of cool rocks and hills and zebras/warthogs/gazelles around. So we biked about 5 km to the gate then 8 km inside the park to get to the rangers post, where we left the bikes to go walk in the gorge. This walk involved a lot of scrambling and sliding and climbing up or down vertical slopes, but we had a really good guide who told us where to step and occasionally lifted up the really high spirited 5 year old that was part of our group. Then luckily we had climbed out of the gorge before it started to pour, so we just had to bike back 13 km in the pouring rain on dirt roads but it was awesome anyway and we had hot showers when we got back which helped even though I had forgotten my towel.

We were staying in the "dorm" at Camp Carnalley's, which was nice the first night but the second night we were joined by a man who claimed Theresa's bed while we were out and then proceeded to cough, grunt, talk, and yell in his sleep all night. Ricky pointed out that maybe he is taking Lariam and having dream-related side effects and so it's not necessarily that he is always a ridiculous sleeptalker.

Okay so then I went to Nairobi to try to find tofu and teff flour but was not successful because I didn't have that much time to look, but I did have lunch at a ridiculously fancy Italian restaurant (I spent a whole $12!!) which was nice but is still not Lebanese. It's strange that I was so excited to go to Nairobi when basically you can get anything you want in Kisumu (except tofu and teff flour, and fancy restaurants) but once I was actually there in the big city I realized it wasn't that exciting, and it's better to live in a place where you don't have to deal with so much traffic!!

Luckily for you, I even have some pictures!

This is an update

Considering I found myself checking my own blog for updates, I figured it was time to write one…

This week has been good, the ILRI vets that came to visit were super awesome and I definitely want to be them when I grow up. One of them has been offered a job as the veterinary medical officer in charge of the CDC base in Cairo. I encouraged her to take it and then hire me! Perfect. They came to Kisumu to discuss some logistics for a participatory epidemiology study they are planning to set up in Asembo, the same area where I'm setting up my surveillance system. There's an ongoing zoonoses project that looks at diarrheal diseases in children under five, and they are doing participatory epi, which involves semi-structured interviews of community members, to determine what local knowledge exists about the diseases. They asked me (or maybe I begged them I don't remember) to help out by evaluating one of the interview teams, and this means I get to go to the refresher training that they are holding and learn how to do participatory epidemiology myself! Then after I experience it we are going to go out and do it for my project! This will establish a baseline of what people know about zoonoses, and then after the surveillance system has been running for a while, or at the end of my time here, I'll do it again and see how things have changed.

We haven't gotten any reports from my pilot villages since the day we implemented it when it turned out the cow was in heat. I wasn't there, so I'm concerned that the animal health assistants may have discouraged the animal health reporter from reporting by making it seem like it was a really bad thing that he reported that this cow had nervous signs. After seeing the presentation on education through listening and talking about participatory epi, I'm really concerned about improving the communication between our animal health assistants and reporters or farmers. So Tuesday I'm going to get the 3 animal health reporters to come in and try to figure out whether there really haven't been any events in their villages (which is possible) or if they are facing some barriers to reporting that we can help out with.

Also, today I moved into a new house! Steph was kind enough to drive down and pick up me and my two suitcases and Marisa's bike and drive me up the road to my new place, which is in the same compound where she lives. Technically I'm renting one room in a three-bedroom house, but there's no one else staying with me at the moment and I'm not sure if anyone is going to come. This means I'm paying about $300 per month for a furnished three-bedroom house with a back garden, an amazing view of the lake and the sunset when it's not cloudy, and a very nice woman named Nida that cleans and does laundry. Plus it's much closer to the center of town, and about a 3 minute walk from where I catch the shuttle to the office, and it has screens on the windows that keep out the mosquitoes! Where I was staying before I was essentially sharing with hundreds of mosquitoes (plus some people that are nice and don't suck blood). The mosquitoes were fat and lazy and I could frequently catch one in one hand absent-mindedly. The only problem with my new house is that it's adjacent to a very active construction site.

Roller Coaster Workload

Soo today was interesting. This morning I arrived at the office as usual but was a bit concerned and not sure what to work on – Various programmer guys were making progress on programming that I am not able to help with, and I felt pretty useless. Every Tuesday morning at 8:30 there is a seminar, so after checking my e-mail and twiddling my thumbs for ½ an hour I went to that. It was awesome. This woman was presenting on her methods of engaging with the communities, called Education Through Listening. She described the technique by forcing the whole audience to participate and asked people to role play, etc. as she demonstrated on us. Afterwards, I acted like a barnacle and sat and listened to her and Steph talk about how Steph can integrate the techniques into her malaria drugs in pregnancy study. I also thought a bit about how incredibly relevant it is to my project (and presumably everyone's). For example, we received our first report last week, but it turned out to be "invalid" because the cow didn't actually have central nervous signs but was actually just in heat. Whoops. So was the animal health reporter over-zealous or did he not know how to recognize that the cow was in heat? What about the cow's owner? I'm not sure, I wasn't there when the animal health assistants responded to the report. My goal on Thursday when I next go to the field is to follow this technique through several levels - ask questions to prompt the animal health assistants to talk about how they can ask questions and listen to educate the animal health reporters on how to ask questions to listen to educate the farmers so that they learn from reporting to us whether or not the report is valid.

This vague thinking led me to wonder how much the farmers really do know – so I'm gonna find out with some semi-structured interviews and also attempt to find out what happened to the never-analyzed data from a previous attempt to find out what people know about enteric zoonoses. Then I'll do a repeat survey later on and see how successful the project has been in terms of education. Okay, by "I" I mean "Eric" because I do not speak Luo. I'm thinking of taking lessons but I also want to improve my Swahili which will presumably be more generally useful in life/East Africa, but I guess Luo could come in handy in the distant future at some point.

In other awkwardness, it turns out that Emmanuel, the guy I met at one meeting and that subsequently confessed his love for me and has been trying really hard to buy me drinks ever since I ran into him at a club a few weeks ago, is the same guy that I desperately need help from on web form-based data transfer and storage.

Alright but the main point about today is that this morning, and even through lunch, I was feeling unproductive and inadequate. Then this afternoon, in addition to thinking about interviews, I met with people working on three different kinds of programming for me – the lab guys that need to put a way to enter our samples into their tracking system, the scannable form guy, and the PDA programming guy. All of these meetings led to suddenly booking up my whole week with more meetings and lots more work for me! Plus, tomorrow two women vets from the International Livestock Research Institute (ILRI) that are doing a participatory epidemiology study related to One Health are coming and I have A LOT to talk to them about! Yay!

 

Standing out

Can I write in 1 pt font?

It's really funny what you get used to seeing, or not seeing, and how what used to be normal can become worthy of a double-take. One such thing for me is dogs. Here, dogs don't go inside, they don't get taken for walks on leashes, they are basically just everywhere running around, and unfortunately frequently get hit by cars. I'm still not desensitized to seeing dead dogs on the road, but I am desensitized to seeing dogs just running free. Yesterday when we were at the fish restaurant it started pouring, and all the dogs came in to the restaurant looking for shelter and curled up really small on the floor. Seeing dogs in the restaurant didn't surprise me. On the other hand, I ALWAYS notice when there is a dog being walked on a leash. It just looks funny. Especially when it's some kind of purebred dog and not a "Kisumu special."

Yummers

So I think "sukuma mimi" was a really really apt title for this blog. I guess if I haven't turned into a pickle or a macaroni by this time in my life, I probably won't turn into sukuma wiki, but I definitely eat enough of it to think I might. Also, it's delicious. When I go to the fish restaurant near the field site where they don't even serve beans (the chicken restaurant across the street does have tasty beans but I'm generally with people who prefer the place that serves tilapia straight from the lake) I get ugali, sukuma wiki, and kachumbari (tomato and onion salad). Like I said, it's delicious. Then I come home and have some sukuma wiki for dinner too, but luckily get some lentils in too.

 

In other news, today I distributed the first of the phones to a few animal health reporters for our pilot run. I also worked on training the animal health technicians in various things including how to send e-mail attachments. I didn't really consider this until now, but of the three of them that were there, one has an e-mail address which he doesn't really use, another set up an e-mail account a long time ago and never used it, and the third has never dealt with e-mail. These are young and educated people that do know the essentials of using a computer but not much more. So, me saying "and then fill out this form and e-mail it to me every Friday" really doesn't cut it. I guess I am lucky to be as computer literate as I am, having the instinct and knowing where to look to solve problems. It's been really great working through everything with them though, because they are super enthusiastic and really want to learn and really contribute to the studies they work on. They also have great ideas and suggestions and can think of a ton of potential problems that I wouldn't think of until it caused a major roadblock. Honestly we come up against enough little problems every day, like there being very little cell phone reception in the office where our cellular modem server is (aggh!), that any chance to anticipate problems is super helpful.

 

This Friday is a public holiday for the promulgation of the new constitution! Whoo hoo! I might take the long weekend and try to go somewhere fun and relatively nearby. Forest, mountain, savannah, lake? WHO KNOWS.

 

 

 

Pichas

So I had grand plans to post a ton of pictures while using fast wireless internet this morning, but then I had to go meet people for Darryn's going away lunch before the second set had finished loading. More to come later, then, including some pics from when I watched lots of people I know capsize in their sailboats in Lake Victoria (home of tons of hippos and crocs) when the wind became suddenly crazy.

For now, these are some from Maasai Mara:
1) a topi, which look like hartebeest with blue legs, and the sunset!
2) leopard vs hyena face-off over the innards of the wildebeest
3) some more dead wildebeest in a river
4) a different river crossing which did not lead to any dead wildebeest as far as I could tell