Boda Boda

Today I am in Uganda! Uganda is so close to Kisumu that it's hard to believe that I am in an entirely different country. I traveled by bus, in "royal" class which means the bus only has 33 giant seats, but there were only about 7 people on it anyway. Luckily didn't miss the bus despite the greatest efforts of the people at the bus station, who kept telling me to wait, don't board yet, they would announce it, etc. However, I was paying attention and so noticed that the bus was about to pull away even though no one had made any type of announcement. We got to the border crossing in Busia after 2 sleepy hours, where I got off the bus, got stamped out of the country, paid $50 to get into Uganda, turned down a marriage proposal, and got back on the bus. They promptly put the big "royal" TV to use and so I got to enjoy one of the great American Christmas classic movies, Home Alone, immediately followed by the other great American Christmas classic, Home Alone 2: Lost in New York. Four hours later we arrived in Kampala, just as it was getting dark. I asked the bus ticket seller guy how much I should pay for a taxi to my hotel, but then the low side of his range turned out to be the taxi driver's first offer. I was too surprised to negotiate, but whatever, it was less than $5, and we had to sit in traffic for a while to get to the hotel.

Now that I have bored you with excruciating details about my bus ride, I will offer some first-impression observations about the differences between Kenya and Uganda.

1. The roads in Uganda are way better than the roads in Kenya. A politician on the radio was talking about fixing the potholes in Kampala, but honestly we drove over one pothole on the way to Kampala, whereas the roads in Kenya are generally more pothole than road.
   
2. Uganda is cleaner than Kenya. The same politician was talking about how he set up a trash collection system in the district he's in charge of. Novel idea. Other than having fewer piles of trash on the side of the road, even all of the dirt looked swept smooth.
   
3. Uganda has a lot more trees than Kenya. I saw lots of big trees, native trees, jackfruit trees, crazy trees with giant hanging pods, and very few eucalyptus trees. I did, however, see water hyacinth in the Nile, so they are obviously not winning all the wars against invasive species.
   
4. Uganda has a lot more inflation than Kenya. Seriously, why keep all the extra zeroes on the bills? Maybe because it makes it hard for us tourists to differentiate between notes that say 5000 and 50000 at first glance.
   
5. Uganda has way different food from Kenya. I'm staying at a hotel which claims to also be a Greek restaurant, but the dinner buffet (15,000 shillings) was definitely Ugandan food – the waiter very enthusiastically recommended the matoke (mashed banana – in Kenya you can get matoke but it's never mashed) and peanut sauce (not as delicious as I expected, but still good, and it was nice to think that it's similar to what Doug is eating every day way over in West Africa) and there were of course a variety of other carbohydrate sources plus beans and cabbage (and meat).
   
6. The color that MTN paints buildings is ugly (drab yellowish) compared to the bright green of Safaricom. Luckily Zain (bright pink) and Orange (orange) are both in Uganda as well as Kenya.
   

Further contemplations about whether these differences are actually true and why that is the case (Less corruption? The tyrannical rule of Idi Amin?) are possibly still to come.

 

Update Time

As I settle into my life here, day to day events seem less worthy of telling everyone about. But I don't want to get in the habit of not posting about awesome things just because doing awesome things is second nature!

In the past couple of weeks, I have had the opportunity to participate in a ton of sweet social events, from (pre)Diwali celebrations to homemade pizza parties to ridiculous Halloween adventures. I also returned to Bondo for phase two of the participatory epidemiology study, where we learned a lot more about people's perceptions of zoonotic causes of diarrhea in children, and tried to brainstorm ways of preventing transmission with the communities. Next time, we'll see whether they were able to implement any of these preventive suggestions and see what the barriers to implementation of preventive measures are. The suggestions include sweeping the animal dung out of the compound every day, washing hands after handling dogs and other animals, preventing babies from eating dung off of the ground, boiling water and milk before drinking it, etc.

Tonight is the real Diwali celebration, with fireworks and food stalls at the Yacht (pronounced "Yatcht") Club. Luckily the Indian community in Kisumu is letting everyone participate, and I am really excited to eat delicious Indian food!

My project is going well, although setting up the lab for the diagnostic tests has been a total nightmare. Yesterday I was optimistic because the lab sample tracking software was working after being down on and off for about 6 weeks, and because the lab manager is back from vacation so I can finally get things rolling. HOWEVER I was just informed that the system is down again! This is especially bad because I won't be in the office at all next week and so far the only way progress has been made in setting up the software is when I sit directly next to the data manager while he works on it.

Next week I'm going to Kampala, Uganda for a conference on M4D (mobile technology "4" development) where hopefully I will meet a lot of people that are successfully using the software programs that I am currently struggling to implement. (Did I say my project is going well? It actually is, for example I'm starting to work with people from the Department of Veterinary Services to find out their priorities for disease surveillance, and I'm trying to come up with a paper to submit to the International Conference on Animal Health Surveillance in France in May...the software challenges are what I end up complaining about, but except for the incredibly frustrating Freezerworks, I really enjoy troubleshooting and I'm excited to see how what I learn next week at the conference will help!)

THEN on the weekend I am going whitewater rafting on the Nile with a few friends that will meet me in Jinja. I am sort of terrified but I have heard from at least 6 people that it is amazingly fun. We'll see if we end up chickening out and only doing Grade 3 rather than Grade 5 rapids. I also found out that it's possible to go on a 6 day horseback safari in the same area (along the Nile in Uganda) which includes one day of rafting, plus swimming with the horse in a "sandy bottomed pool" (in the river, great way to get Schistosomiasis, but…it's treatable…) and riding through forests full of monkeys and exotic birds! I would love to do that when I have an extra couple thousand dollars lying around…who wants to join me?

 

COOL

Some people found a medieval mass grave in Germany and used PCR to isolate Yersinia pestis (plague) DNA! Crazy! Extremely delayed autopsy!

Also cool is that today I managed to actually get some test data collection forms running on my test Android phone! And I met some guys from the Task Force for Global Health in Atlanta that are also using Android-based data collection tools (for a schistosomiasis study)! Luck!

Further updates soon, but my primary feeling right now is that time is flying way too fast and I'm having trouble keeping up.

Rinderpest and HIV and Rabies (Oh my!)

Good news – Rinderpest has been eradicated! Bad news – there are still a ton of really devastating infectious diseases out there (and right here), and many of them are not likely to ever be eliminated.

I'm currently reading Paul Farmer's book Infections and Inequalities: The Modern Plagues which, in combination with conversations about some friends' research on HIV, has really gotten me thinking about what's going on here in Kisumu and the rest of Nyanza province. In this part of Kenya, the HIV prevalence is the highest in all of Kenya – despite CDC/KEMRI and an enormous number of HIV-focused NGO's working in the area. There are various estimates of just how widespread it is, but all of them indicate that the answer is "very"… a friend's poster I read recently says 25% of women and 18% of men are infected, and another study conducted in 2003-2004 in the district where I work found that 36.5% of women aged 25-29 and 41.1% of men aged 30-34 were seropositive. The other night, as a birthday party I was at was winding down, a couple of drunk HIV researchers brought up their work. One woman is studying the impact of coital injuries on transmission, and she indicated that there are a number of cultural practices that significantly increase this risk, but the primary risk for women, as Paul Farmer also discusses, is being poor and therefore having very limited sexual agency. Back to cultural practices, though, because other friends of mine are assessing the acceptability of male circumcision in this area where traditionally circumcision has not been practiced (male circumcision has been shown to reduce the risk of transmission of HIV). The majority of people here are from the Luo tribe, who not only don't traditionally circumcise, but have a number of other traditional practices that really don't help slow transmission. According to my friend, many Luos engage in concurrent relationships, which basically means that any "ex" isn't ever actually ex. I also keep hearing about the importance of sex in funeral rites, although I haven't ever been able to get a clear picture, and this article is not available for free. ( Does someone with library access want to send it to me?) My very basic understanding is that recent widows have to be "cleansed" by having sex, and widows are also inherited by their deceased husband's brother. You can imagine that when a man dies of AIDS and his presumably also HIV+ wife is forced to take another husband this can contribute to the spread of HIV. I just found another article which includes all of this stuff, please read here.

Okay, now some optimistic news – my supervisor's supervisor, Sarah Cleaveland, has devoted her career to eliminating canine rabies and the human rabies cases that result from it. It will be a very long time until the Wikipedia page for Rabies says "was an infectious viral disease" [can you imagine how gleefully that edit was made??] but Sarah has shown that it is possible to eliminate canine rabies and that a lot more attention and resources should be directed towards this task – currently there are about 55,000 human rabies deaths each year, with almost all caused by bites from rabid dogs, and of course, the vast majority are in Africa and Asia. I haven't done the calculation myself but according to Jo H. that means someone dies from rabies every 8 minutes. Sarah also played a large part in the founding of World Rabies Day, and here in Kisumu we are doing our part in extending it to last all year (it was supposed to happen in late September) because our shipment of rabies vaccines has been delayed. Our mass dog vaccination campaign will probably happen this Saturday or next, and I'm super excited to be a part of it. Rabies is a disease that I find fascinating, it's a deadly generalist virus that can infect essentially any species of mammal, and the reservoir of domestic dogs with rabies has led to devastating outbreaks in lion and African wild dog populations. Thinking about the ecology of all the interactions and connections…wow. And it's vaccine preventable! Seems like a good disease to devote a career to. But there are so many other neglected diseases…good thing no one is forcing me to pick one disease to study!

 

 

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.