Happy Half Birthday to Me!

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

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

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

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

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

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

This is not a real update

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

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

IDEAL (More about cows)

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

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

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

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

Younguns

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

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

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

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

Oops

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

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

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

To Hell’s Gate and Back

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

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

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

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

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

Luckily for you, I even have some pictures!

This is an update

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

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

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

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