Lyonnaise is much better than Mayonnaise

Hello everyone,
I apologize for the extremely long delay in posting. There have just been so many better things to do!!

For the past week, I've been in Lyon, France at the International Conference on Animal Health Surveillance. I got to do my first ever conference oral presentation, and luckily got it over with within just a few hours of the conference beginning. For the rest of the time I have been enjoying the conference, which was held in a pretty amazing chapel, and not eating the incredibly fancy but undoubtedly meaty hors d'oeuvres that were served (for example, there was some tiny pita bread filled with an unidentifiable substance, and they were held closed with TINY CLOTHESPINS! and balsamic vinegar and soy sauce and such things were served in small pipettes. It's so modern.)

One of the people I met at the conference was the Principal Investigator for that participatory epidemiology study I helped out with a while ago - and after discussing some stuff with him it looks like we will finally move forward with writing that up! Hooray.

Otherwise, this fountain fairly accurately represents how awesome Lyon is. Lyon is a goddess riding four mythical (their hooves have weird claws) horses with steam coming out of their noses. Although the city's claim to fame is being the gastronomic capital of the world, my desire to not eat veal or mussels has limited me somewhat. But tonight I ate at a great vegetarian restaurant (Zone Verte) which is right around the corner from the hotel. They serve only fresh, local, organic food and they serve it on wooden trays which fit perfectly into slots on the table. It is fun.

So the week before the conference, I was busy hanging out at the coast with Christina, who came up from Lesotho to visit! Vacation is hard work and I had barely any time to practice my presentation. For example, we visited the Gedi ruins in Watamu. It's a cool place - a Swahili city that was active from the 13th-17th centuries.

We also visited the amazing and empty beach (it's low season because it's rainy season so there is some seaweed) and played in the water a lot.

The sand is very white.

It was awesome. That's all.

I think I didn't know before how much I like the beach. We went snorkeling and it was like swimming in an aquarium, so many fish!! Amazing. Will have to come back during November when the sea is a bit calmer and you can find dolphins.

One of the most amazing things about Kenya is the incredible range of ecosystems and cultures and landscapes. Lyon is amazing too, as I mentioned. Traveling is awesome but I have been feeling torn between really wanting to actually live in a place (an amazing place, hopefully Pullman lives up to that standard next year...) and wanting to keep seeing new places. Perhaps the solution is to take reasonable length vacations interspersed with having one place to go back to. Something to work towards in life I guess!

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?

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 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.