Going back?

It's reunions this weekend (but I'm not there), my little '11 buddies are all grown up and graduating, and I have less than a month left in Kenya. A few days ago I wrote some reflections in order to help me try to decide what to do in my last month to finish up my project, but it turned into more of a personal reflection. So it seemed like a relevant thing to turn into a blog post, although now that I reread it it is largely nonsensical:

Today marks exactly one month until I fly back to the US and head almost directly to the Compton retreat in San Francisco. That means it’s been about 11 months since our retreat last year and just over 10 months since I arrived in Kisumu on July 19, 2010. The other night I was talking to Ricky and he was commenting on how looking back on the beginning of his time here (he arrived around the same time I did) everything seems sunny and happy and in recent months he has become more stressed about his work, more tired of the tiring things about living in Kenya, and more ready to go home. So I had to think about whether I have gone through a similar transition – was I happier when I started? Am I ready to go home? Is that a result of failures and challenges or just a desire to have fast internet and be able to relax and not stand out every time I leave the house?

In my first five months here I had no thoughts of wanting to leave. After I went home for Christmas, came back, and left again for my time in the UK, the idea of being back in a developed country, with my friends from college and where everything is easy, started to appeal to me more. Now, as my departure date approaches, I feel less ready to leave the great friends I have made here, abandoning my project, the beautiful weather, affordable living, access to incredible places. To make up for it I have planned to visit about 6 US states and 3 countries in the summer before starting graduate school next year. I think my experience in Kenya is roughly paralleled by the weight I have gained and lost this year – ten pounds on gradually, represents filling myself with Kenya and starting to feel like I don’t fit in my current set of clothes, need to change and shed and start over in a lot of ways. Most of that 10 pounds off again, still sticking with my new clothes, my new life, but being better able to control myself and no longer needing to gorge on Kenya-ness and feeling a better sense of fitting in here in relation to fitting in elsewhere, home in Kenya, home in Europe or the US, home nowhere, but it doesn’t matter. I am so lucky to have this experience, and I tell myself this every day. I am 23, and I live in Kenya, I travel to France for conferences, I can communicate online with people back home, and I am managing a project that involves Zebu cattle and learning about diseases and public health and pathology and technology and research and management. I think I am ready to go home, to start grad school, be taught microbiology and statistics and research practices – this year, I opened up the spaces in my brain by trying to teach myself all of these subjects and more, and next year, I will start to fill in the gaps and I will be able to do such awesome work when I come back to Kenya to do my MSc research.

Has the US changed since I’ve been away? Will Kenya change over the next year when I’m gone? KEMRI/CDC is facing major budget cuts, laying off close to 1/3 of all staff, cutting programs, cutting global health research. Will it be a different center when I come back? Or will it be the differences in my perspective and knowledge that are more important than these logistical transitions?

Well then.

For the past three weeks I have been doing things that don't involve creating blog posts. But luckily, for half of that time I was on vacation with my family and they did an excellent job retrospectively tracking our journey. So, although most of the readership of this blog was actually on the trip with me, those additional few might enjoy seeing the photo summary of our trip.

Since being back in Kisumu and sending the fam back around the world, I have been mostly having meetings and hoping that these meetings lead to progress. For now I'll have to leave you in suspense on whether that progress is actually occurring and get back to trying to make it happen.

Scotland is greyt

This past weekend I did some things which I can do in Kenya (lay around in bed; overheard conversations that at first seemed like a language I don't know and then turned out to be English) some things which I maybe can do in Kenya (saw The King's Speech with Brits that didn't know it was about Elizabeth II's father; went shopping and had to deal with huge crowds of people; watched Scotland vs Wales Rugby at a pub), and some things which I definitely can't do in Kenya (stream TV shows over the internet; take the bus from right in front of my house directly to the Royal Botanic Gardens!)

The view of Edinburgh from the Royal Botanic Gardens.

It was great but I did spend more time than usual by myself and I miss all my friends in Kenya. Being somewhere for only a month when everyone else lives there permanently isn't the best way to meet people, especially when there isn't a community of expats that you automatically join by being obviously foreign. Plus my flatmate Amy was busy because her boyfriend was visiting from some only slightly distant place.

On the other hand, I am really enjoying working here, the people are great and focusing on data and programming is a fun change: I did some productive internet stalking to find a guy who may or may not have developed a mobile phone based diagnostic support tool (he agreed to send me more details but hasn't yet), remembered how much I enjoy applied math, and applied said applied math through some R codes.

On the other other hand, I keep forgetting to put on my coat before going outside...

Wienerconference

Hello again! It's a beautiful day in Edinburgh, and I'm sitting at Roslin, overhearing conversation about research on chicken breeds. I contemplated working from home since none of my people are actually at Roslin today, but I realiSed that having a place to GO to actually makes the day feel more productive. Although maybe it's not, since I'm clearly writing a blog post instead of R code.

Yesterday I gave a presentation for the Epigroup meeting at King's Buildings, which is one of the other University of Edinburgh campuses, and I got to meet a lot of evolutionary biologists at tea time. I tried to convince them that I know something about evolutionary biology since it was half of my major but it's not really true. Oh well. The tea break was held in a room called the "Darwin Dance Hall," so that's amazing. But anyway, continuing to move backwards in time, this past weekend (Friday to Monday) I was in Vienna for the International Meeting on Emerging Diseases and Surveillance, with my buddy Dr. Jo. I presented two posters and she did a talk and we ate a lot of falafel instead of not-delicious traditional Austrian veggie options and it was super fun - story in pictures below. Since the internet works here!!!

1) Vienna is amazing. They have an ice rink which they call Wiener Eistroum which sadly we didn't get to skate on because they were zamboni-ing. It's got cool long narrow pathways and is not just a regular oval rink.

2) I don't know why I'm numbering these because they are very out of order. We had dinner with a friend of a friend of a friend's friends at an AMAZING Pakistani buffet place where you pay as much as you want to!!! Plus the veggie options were amazing and all vegan.

3) We also went out for some famous Viennese cake and late night coffee at an awesome packed coffee house with an awesome atmosphere.

4) Every night we walked back to our budget, non-conference hosting hotel past this ridiculous building with a crazy lit up ceiling. Still don't know what it is.

5) Eventually, I remembered to take out my camera when it was light out. This building is covered in scaffolding that is printed with an image of the building. CLEVER.

6) Flying out of Bratislava I was reminded about ONE HEALTH. Hoorah. Speaking of flying, I am very proud of my success at smuggling a 4 foot long poster tube in addition to my carry-on bag onto both Easyjet AND Ryanair. On the second flight I was aided by the incredibly long coat of an American that I randomly met while waiting for the bus in Bratislava.

7) Bratislava has a cool changing of the guard thing going. This was before I went to the airport. (I took a train from Vienna to Bratislava to get a direct flight back to Edinburgh. Sadly the high-speed catamaran ride up the Danube wasn't running at convenient times.)

8) Bratislava is not as clean as Vienna. It felt fairly depressed. But on the other hand I spend less than 5 Euros on a meal of the most amazing sandwich ever plus a decent sized glass of incredibly delicious fresh squeezed orange juice at a cafe called Tri-sty-ri which had a bookshelf with a door hidden in it. So overall a good experience. Slovakia: CHECK!

Vitamin D

I don't have much to say about life other than that since getting back from my visit to the US I've started missing things like fast internet and being able to drive myself around. Exactly one week from now I will be in the UK, and so the internet problem will be solved. Unfortunately the trip also means giving up sunshine and blue skies for quite a while. But, when you have the internet, you never need to go outside, right?

In terms of the project, I had a frustrating and depressing week last week trying to make things happen before I leave for Scotland next Monday, but Darryn pulled through in a Skype call and gave me just enough mentor encouragement to rekindle my optimism and help me get things done. So, reporting is starting up again this week, yay!

It is also necessary for me to post a picture of one of my favorite new puppies. Unfortunately, the internet just can't handle the picture uploading thing so you'll just have to make an assumption about her cuteness. In the comments, please debate about my puppy-acquiring aspiration. I'm pretty sure it won't be impossible for me to bring her back with me to the US in June.

Vacation is Nice

Well I'm back in Kenya, where it is nice and warm and sunny and happy. Except that there was a ridiculous thunderstorm yesterday, and I got pretty soaked.

Unfortunately, nothing gets done on vacation and the frustrating roadblocks that were slowing my progress in December before I left are, for the most part, still there.

But I am happy to be back, I really enjoy being here regardless of the status of the project.

Here's an excerpt from my mid-year report draft for the Compton Foundation, which expresses a general reflection on the past six months:

I’m back in Kenya now after a holiday break at home in the states, and it is really nice to be back. I feel at home here and I think that feeling is a very important accomplishment of my fellowship so far. Of course, the incredibly beautiful weather doesn’t hurt. While in the US, I hoped to be able to spend a lot of time reflecting on the past six months, but I ended up really taking a break and disconnecting myself from everything in Kenya for a couple of weeks. This turned out to be great and helpful, as I eventually realized that I hadn’t taken any psychological time off from my project since arriving here in July.

When I arrived way back in July (how is it possible that it can feel so long ago and yet also feel like time has gone by incredibly fast?) I didn’t know anyone or how to get around town, hadn’t met my mentor in person, and had very little hands on experience with the mobile technology I planned to use for my project. Right away, I made friends with a couple of the people I was staying with, and they helped show me around. I had a meeting with Darryn where we established a framework for the project plan and I learned that he would be leaving for a job in South Africa in September, and then I jumped into the project. It’s been pretty much a whirlwind ever since, both in the sense that it’s been incredibly busy and in that I feel like progress is more like a corkscrew than a straight road. Looking back on my notes from early in the fellowship, I see lists of tasks, many of which are no longer applicable or still haven’t been accomplished.

I’ve asked myself many times why progress is so slow and seemingly circular. I’ve tried to blame myself for not working hard enough, and spent a decent number of weekends and evenings working or telling myself I should be working. Luckily, I’ve made enough friends here that I now usually have plenty of excuses to relax on the weekends. Getting used to a working lifestyle rather than my school lifestyle has definitely been interesting – sleeping from 11 pm to 7 am, working from 8 to 5:30 and coming home and cooking dinner certainly contrasts with the unpredictable schedule I had at Princeton: eating when I was hungry (dinner at 3 pm or 10 pm), sleeping when it was absolutely unavoidable (often at 2 or 3 am, occasionally later) and thinking that class at 10 am was a bit too early. When I went back to Princeton for a night while I was in NJ, I was pleased to not be writing papers or studying for finals, and I told my friends that are still there that life in the “real world” is great!

Does a Compton Fellowship count as the “real world” or is it something else? If the rest of the real world is almost as unrepeatable, unforgettable, and amazing as a Compton Fellowship, then I’m glad to be a part of it. I think a large part of the Compton Mentor Fellow experience for me so far has been allowing myself to be convinced that I am qualified to be doing this and that I deserve to be here, while also increasing the depth of my understanding of how lucky I am to have the opportunity to do this. That luck has allowed me to get to know great people in an amazing place while many people I know at home or unemployed or struggling to enjoy their work. I’m also lucky to be working on a project where I can try to improve the health of livestock and therefore improve the lives of the people that rely on them. Seeing the poverty in this area, and learning about the HIV/AIDS prevalence (the highest in the country) and the high rate of malaria, as well as other infectious diseases, especially zoonoses, has made it easy to see why moving away from the easy life in the US in order to try to make a difference is worthwhile. The challenge is making that difference, and making it sustainable, and assessing whether the people here actually feel like a difference has been made. Even though I know I won’t accomplish everything I want to by the time my fellowship year is up, I will at least have opened up opportunities for myself to continue to work to improve the health of animals and people.

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?

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.)!!!

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.

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.

A few snippets

The canteen here at CDC/KEMRI is amazing. Today for lunch I got an enormous plate of beans, mung bean stew, vegetable stew, plantain, rice, chapattis, and sukuma wiki for about 50 cents. DELISH.

Also in food news, my housemates and I had an awesome Kenyan dinner last night prepared by a couple of the guys that we know, followed by a conversation in which the Kenyans argued that divorce does not make sense and we argued that their lack of understanding of divorce did not make sense. Not very productive in terms of changing the views of either side…

CDC/KEMRI is awesome and has seminars every Tuesday morning at 8:30 so this morning was a presentation on repeated segments of DNA and how they can impact susceptibility to various diseases. Super cool, and my MOL 342 knowledge came in handy for understanding what the guy was talking about. Yay college.

The project is going well so far, too, except for FrontlineSMS somehow totally breaking down yesterday because they used a trial version of software to create the newest update WHOOPS (now fixed apparently but I haven't yet reinstalled). I came up with a pretty good diagram of how our information transfer will go (farmer > community reporter > animal health assistants > program manager (me)) and thought through the logistics of reimbursement and data transfer. Next week is the referendum election on the new constitution (and I'm going to go up to Mpala) so everything will be totally shut down, but after that we will be training the animal health reporters in using FrontlineForms on their cell phones (that I still have to set up) to report when there is an incident in their community. We also have to train the animal health assistant response team on the clinical signs collection protocol and diagnostic sample collection for the 20ish diseases that we are concerned about for now, that's what I'm working on putting together at the moment with lots of help from my favorite book, Infectious Diseases of Livestock (3 vols.). Darryn is going to be working directly with the author/editor in Pretoria pretty soon, but he might not be able to get me a free copy OH WELL. But in any case overall I feel like I have some good short term goals set up and know the way forward a lot better than I did before.

I got to go over to help identify a couple of ticks that Alice was having trouble with, and wasn't actually that much help, but did get to see a cool Amblyomma adult that looks tiny, pale and sickly because it fed on a less than ideal host, like a chicken or something, as a nymph and therefore was not able to develop into its usual impressive adult form. COOL.

There are tiny ants on my desk that hopefully are helping me by cleaning my keyboard. But possibly they are disassembling my hard drive piece by tiny piece.