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.