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

I Like Cows

When I was at Maasai Mara, one of the women I was with was telling a story about her 5 year old cousin who lives in Uganda. She had control over a camera on some vacation that her family took, to places where you can see giraffes, lions, elephants, zebras and other exciting animals. When they got back and she showed her pictures to everyone, they were mostly of cows, because they are her favorite animal. It's hard to believe that someone would find cows more exciting and photo-worthy than the wildlife in this part of Africa, but I can definitely understand why she likes cows. Last year at Mpala I was so frustrated by the fact that I couldn't get close to any of the enormous amount of wildlife that we saw, so when I had the opportunity to play with a dog or pet a cow I was super excited. Yes, that happened less frequently than seeing exotic wildlife.

Today I had a great time out in the field for the training session. We arranged for a man named Julius who works for a study that we are collaborating with to come up and teach our animal health assistants about how to take certain samples including how to make, stain, and read blood smear slides. I loved getting to interact with the cows, and learning some clinical skills. One of the cows was super friendly with Darryn, unfortunately I missed the photo op of her licking his face, but here she is being curious about what we're doing with all these slides with her blood on them.

On the other hand, I am unfortunately having some trouble getting FrontlineSMS to work on the computer in the field lab, and having trouble with FrontlineForms on the phones for the animal health reporters. All around troublesome. Based on this, and the fact that the lab isn't yet ready to process samples from the project, and so we can gauge how many reports we will get, and for a few other reasons we're going to start out by implementing the system on an even smaller scale than our original limited implementation plan. That means doing it in two villages, with limited sample collection and limited clinical signs collection until the systems are up and running. I think the training we did/are doing this week is still really useful, but having done some training doesn't mean the project is ready to be launched. In a few weeks when the software is ready and the lab is ready we can really get started, and we'll do another more realistic training then, because we'll have everything ready (hopefully). Darryn's leaving at the end of next week, and I think that will be a great kick in the pants for me to take charge and not rely on him so much, or rather, I guess, start relying on a wider range of people. It makes sense, too, that he wanted to do the training before he left, and to push me to get things going, but it's fairly obvious now that there just wasn't enough time, even though I was making powerpoints late at night for several days in a row.

The time has gone by pretty fast, as in I can't believe this week is almost over, and it's also strange that I have now been here exactly one month. I think this is a good opportunity to spend some megabytes and post a few more pictures.

This is me preparing my veggie concoction the night that the others ate freshly killed goat at Maasai Mara, the goat is on sticks on the leaves on the left side of the picture, the woman behind me is Marisa.

Birds are often crazy, but this one was especially crazy and was always always playing with the mirror of the car.

The dogs that live with me, Kiki and Nene, briefly sitting still.


These next two pictures are for Sarah. Delicio ketchup ("Tasty just got tastier") and an elephant in the now super green glade at Mpala.

Cows, bikes, malnutrition

This past week has been busy, I think, but it went by too quickly to really be sure. We're still planning to train our Animal Health Assistants (the primary response teams) and our Animal Health Reporters (community members who will pass on reports of sick animals from the farmer using an SMS form) Wednesday through Friday next week. There is a ton of work I have to do before then, like prepare to give presentations on a whole lot of stuff that I have very little or no experience with, like how to take a fine needle aspirate sample from a cow's lymph node. Luckily, actually-qualified-Alice will be doing most of the practical training, and I just have to pass on all the knowledge on procedures etc that I have been learning from books, and explain how the whole system works and what people's roles are. For the practical part, we have apparently been able to acquire a fetus and a dead animal's head (from the slaughterhouse), and we have a live cow or two to assess for symptoms and take blood smears from. Um, in other words, I expect to learn A LOT by "giving" this training.

MEANWHILE, I had to buy and register 40 sim cards for our Animal Health Reporters, the request for which led to some really surprised salespeople. Also meanwhile, I borrowed a bicycle that no one is using (owned by Marisa's project) and got it tuned up and new innertubes put in for about $9. I found a street stall selling helmets yesterday, which supposedly go for $8 pre-bargaining, but I'm not sure about their quality. Today I got a chance to take the bike out on its inaugural ride and I went to meet Beth and a few people she works with at Milimani Resort to swim in the pool and have lunch. It is actually a super amazing pool with underwater stools next to a bar place where you can get sodas and chips and real meals, but we got out of the pool to eat. You can also swim right along a little corridor to get to the changing rooms. It costs $2 to swim, and on a Saturday afternoon the place was pretty packed. Lots of kids splashing and yelling. I had a nice chat with a young woman (Millicent) and her 18 month old baby (Vanessa), Millicent is studing nutrition at a university in town and has just finished her first year. She asked about what it's like in the US in terms of malnutrition/overnutrition etc., which got me started explaining about food deserts and environmental justice and obesity related to poverty in the US, all problems which are obviously different to the slums and malnourished children with TB that you find here. Linda has been volunteering at a malnutrition clinic a bit, and they have to give every malnourished child antibiotics and dewormers in addition to food. Millicent asked if I thought she might be able to get a job in the US after she finishes her degree, but I said I think most US NGOs do work on nutrition out here…

Speaking of jobs, it has come to my attention that I might have to start thinking about what to do next year ALREADY even though I've only been here a month. Ugh.

 

 

 

Plans Plans I love Plans

Today has been good, project wise! Yesterday I became a bit overwhelmed by the idea that we scheduled our training sessions for the Animal Health Assistants and Animal Health Reporters Wednesday through Friday next week, which means I have to get all the training materials together and have everything ready for rolling out the report receiving and response doing (um, responding). But actually it feels great to have some time pressure and to force myself to reach a lot of small goals instead of doing random things towards general progress. So yesterday I stayed up late putting together a spreadsheet of how the data collection should be programmed, with all the skip patterns and stuff so that the response team is prompted to collect samples based on species of the animal (just cattle, sheep or goats for now) and the syndrome they are exhibiting (abortion/stillbirth, central nervous system signs, blood in urine, live birth). It was an awesomely fun logic problem to work through because each combination of species + syndrome needs different samples, and there is a lot of overlap in all different directions. This morning I put it all into flowcharts using a free trial of some software, and even tricked the program into not putting the "THIS WAS MADE WITH A TRIAL VERSION" label over anything important! Whoo hoo. Anyway, then I slapped together a presentation, luckily I had made some relevant slides before, and presented on my project (ADSARS – Animal Disease Surveillance and Response System) at a mobile technology working group meeting. This group has met once or twice before, and so the meeting started off with some discussion of progress towards the set up of a system where people can use the web browsers on their mobile phones to submit forms of data that can then be accessed from the web, which is potentially awesome for centralizing health data. Anyway, I might work with those guys at some point to try to set up a similar system for our lab results to be sent back to the response team so they can inform the farmers as soon as possible of the results. The group seems like it will be an amazing resource, everyone is interested in helping everyone out and seeing how different technologies work. We then met with the programmers and made them totally stressed about the fact that we want the sample collection program done in 2 weeks, maybe 3 (so that maybe we can start collecting data before Darryn leaves for South Africa). I really want to work closely with the programmers (Alan and Noel) but I feel like they are pretty skeptical of me since I am always dressed in grungy field clothes in the office (oops) and I don't have any authority. I really enjoyed the programming class I took and I also really enjoyed working through the logic spreadsheet for the program but they are total experts so I don't know if I would actually be helpful other than providing some impetus to get the work done. We'll see, I'm going to sit in on their meeting on Thursday I think.

So basically it felt great to really hammer out some progress due to imminent deadlines, and hopefully tomorrow I will be able to get going on the training material and other necessary and urgent items such as installing software on 45 phones. Coetzer of Infectious Diseases of Livestock fame who I mentioned previously as being Darryn's future boss had some slides for training for this other project that we are building off of (the same project people that I will be working with in Edinburgh to set up a diagnostic toolkit) but it's entirely pictures with no text. A lot of the pictures I recognize from the book, haemorrhaged brain cross sections and gross lesions and whatnot (side note: there are WAY too many letters in British spellings of medical terms…diarrhoea, oedema, dyspnoea, anaemia). However, not actually being a vet, most of the pictures I really have no idea how to interpret. Darryn said he'll go through and make some captions for me so I don't have to flip aimlessly through thousands of pages attempting to match pictures. Today I also started to gain more confidence in terms of this being my project and feeling like I am getting things done.

Okay but in the big picture another great accomplishment today was creating a broad and tentative timeline for the rest of the year. What I hope to have implemented before I leave in December, so that in January I can get going on creating a diagnostic system in Edinburgh, and then have the system up and running at full-ish capacity in March and April, which hopefully means things will be going smoothly enough for me to visit OuagaDOUGou then and, as Darryn pointed out, find another job for next year L. And then I'll spend the last month or two analyzing the system with the human disease data. OH BOY.

So there, I hope that information was followable and now everyone probably has a slightly better idea of what I'm actually doing. I keep meaning to inform you all in my blog posts that I really would love to hear feedback in the form of e-mails or just comments or some kind of contact, because although by writing a blog I am sort of contacting a ton of people at once I receive much less feedback than if I were sending e-mails to a few people individually. So say hello, please. Tell me what you are up to!

More Matatu Adventures

So apparently no matter what something happens to make the trip between Kisumu and Mpala last 10 hours (n=2). This time for some reason the matatu to Nakuru decided it was only going to Nyahururu so we had to wait for another one there. Then in Nakuru I was successfully scammed into paying $3 extra for my ticket…everyone riding with me on the matatus had been so nice that I forgot not to trust people that try to sell me tickets on the street. Luckily they actually did get me a ticket, just for too much money. ANYWAY now I know how that one works and it won't happen again, and $3 is not so much. Also, in general in terms of travel I think it is very fortunate that I don't get frustrated and upset by delays and can be relaxed and know that we will get there eventually. It helps. Also, we saw TWO overturned trucks on the road, thankfully neither of them was carrying people on the roof, and also thankfully neither of them was a petrol tanker, which seem to make up at least 50% of trucks on the road. One of them was carrying sticks, which I determined must have been sugarcane, and people were happily looting it and taking a few sticks each. It's really interesting that people here will all crowd around an accident, and loot (which is especially horrifying when they are stealing petrol and then it explodes, like what happened TWICE (at least?) last year), and also apparently occasionally mobs take it upon themselves to punish people…I was just reading in the newspaper that some people were driving in a car that someone claimed was his which had been stolen, and a mob started to beat up the guys in the car until the police intervened, and drivers that hit people will get attacked too...

ANYWAY ANYWAY everything is wonderful, really, and the drive through the Rift Valley is beautiful, and tea plantations are an obscenely bright shade of green, and the referendum passed peacefully!! Work on the project is coming along, I wrote up most of our sample collection protocols and this week we are meeting with a mobile phone technology working group at CDC/KEMRI and I think I will present on our system as we have it worked out so far, and maybe get some suggestions for how to best handle data transfer! Whee.

Referendum

So far it seems like the referendum has passed, smoothly, with no violence! Hooray! I'm going to head back to Kisumu tomorrow, assuming nothing changes. I'm excited to see how the implementation of a new constitution actually happens, and how it affects everyone. A brief article on how that might occur/what it entails is here.

Maasai Mara and Mpala and election day!

I’m at Mpala now and it is sooo green. There apparently has been a lot of rain, like basically 9 straight months of rain, which is nice considering the last time I was here the river had dried up. It is also great to see everyone who I worked with last year, and Theresa and Morgan from EEB are working up here for a year. I arrived last night after a long and adventurous series of rides on matatus from Kisumu – the one from Kisumu only made it to Kericho where our driver was arrested (for pulling over and stopping on the side of the road, maybe, which is illegal, maybe?) and then we were at the police station and the police gave us money to get the rest of the way to Nakuru since we had already paid, so we got 200 shillings each and then negotiated to pay only 150, so we scammed the police into giving each of us 50 shillings for our trouble. Sweet, sweet corruption. Anyway, the rest of the way was uneventful except that on the way from Nakuru to Nanyuki I was sitting next to an mzee that I thought I recognized…it turned out I was right and it was Tenai, one of the field assistants/best trackers from Mpala who we interviewed last year when making our video about water, so we went the rest of the way to Mpala together.

Today is election day for the referendum. Everyone is talking about it, and apparently Nanyuki is crowded with people there to vote. I hope it passes – the new constitution will really give people a lot of hope for fixing the country. Then of course I have to hope that it actually does make changes that will help Kenya break away from corruption, and not squash people’s hopes again. There are A LOT of changes, though, and ones that will take a lot of effort and energy and investment to implement. Basically, the whole political system would be restructured, with local county-type borders changing so that there are fewer municipalities and therefore fewer levels of bureaucracy. The court system would be reorganized, with Islamic courts recognized in certain cases. The cabinet of the president will no longer be allowed to be members of parliament as well, and maybe MPs won’t be allowed to raise their pay every time they pass a bill. Land that was acquired illegally will be reclaimed by the government, and the president will no longer have the right to grant land to whoever he wants (which is what after various steps led to the whole Mau forest issue and the deforestation and lack of water etc etc.) SO the people that are opposed to the new constitution seem to be the tribes that are worried about losing the land that was “irregularly” acquired in previous generations. In one Kenyan’s words, the election will go smoothly and there won’t be any violence as long as “yes” wins and the election isn’t rigged…

Anyway, this past weekend I went to Maasai Mara with Darryn and Nat and Marisa and Claire and it was great. Here are a couple of pictures of when we encountered a face-off between a leopard and the hyena that stole a wildebeest from it. I’ll upload more to a web album as soon as I can get internet on my own computer.