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 Looking back on my notes from early in the fellowship, I see lists of tasks, many of which are no longer applicable or still haven’t been accomplished.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.

wow fast internet

Just thinking how even though I'm home in NJ now, and the internet is super fast, I don't really feel like using it. Also been thinking about how lucky I am to live in Kenya. I wanted to find some pictures to convince you of that, but it's hard to express in pictures I guess. Come visit! I'll be back there Jan 8.


Those are impala on the side of the path.


Crater Lake, Naivasha.

Life on a Sugar Plantation

As you may recall from my last post, this past week has been incredibly busy as everything that needs to get done before the end of the year pretty much fails to get done. We successfully received our VIP visitors although we don't know yet how much they want to collaborate with us. On Friday CDC/KEMRI had a big retreat with enforced fun for all of the staff, including such amazing activities as an eating contest and trust falls. We (Darryn, Jo, Steph and I) escaped a bit early from the big day for our own personal working/writing retreat at a farmhouse about an hour outside of Kisumu. As you can see, it was both relaxing and productive, if you pretend that I could see my laptop screen while sitting in the 90 degree sun.

But honestly we did get a lot of work done, and went on a couple of horseback rides around the amazingly green landscape that is the sugar plantation. Actually it's not JUST a sugar plantation, they grow coffee, raise cows and make cheese, breed horses (they have 65) and run a guesthouse. Oh, those Kenyan Cowboys really know how to live the life! A few other visitors (two vets and a veterinary immunologist) came and joined us for the second night, bringing along a 12 year old Australian Cattle Dog that has lived on 4 continents. We had a lot of good talk about zoonotic disease surveillance etc leaving Steph to hopefully make progress on her solely human related work. The immunologist did her PhD and a postdoc at UCDavis before coming here. Honestly I meet more people with Davis connections than seems at all possible.

On the way back home this afternoon, we stopped at Tilapia Beach for lunch. This is the view over the "lake" aka invasive water hyacinth field... it drifts around disconcertingly and is sort of nauseating to watch because you don't really expect what looks like green land to be moving.

Tomorrow we have the day off for Kenyan Independence Day (actually today 12/12), Tuesday I'm going to the field to officially end the pilot stage of the surveillance project so that we can start afresh in January with a system that hopefully will work consistently, and Wednesday I fly to Nairobi for important work meetings with the important visitors from last week, then don't bother coming back to Kisumu before flying back to NJ on the 22nd! Wowee.

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?

Kenyan Thanksgiving

As you may know, one of my favorite recipes ever is Potato and Kale Enchiladas from Veganomicon, which I'm excited to say I was successfully able to make (Kenyan fusion style) for Thanksgiving Potluck Part 2. I'm even more excited to be eating the leftovers for breakfast right now, along with Silk soy milk that a friend bestowed on me after her parents brought it all the way from Pennsylvania, and pistachios roasted with salt and lemon. Kenyan fusion style means cassava instead of potato, sukuma wiki instead of kale, cashews instead of pumpkin seeds, and a friend's homemade tortillas/chapattis. The non-Kenyan part is the delicious spiciness and lack of cornmeal. I bought the cassava when I was out in the field the other day, and for $.75 got probably 5 kg of awesome fresh cassava, so also had to find another cassava recipe, and although I thought long and hard about making this, and following carefully the directions at the end:

• 25 After eating, wash your hands and take your plates to wash
  
• 26 After washing, keep them in the safe place and rest for some minutes in order to allow your food function well into your body.Here you may call it a day
  

I decided that garlic and lime (all small sour citrus fruits are called lemon here, actually, regardless of how dark green they are) would be the best ever, because honestly why isn't everything garlic and lime flavored, and made this one.

All the food brought by everyone else was obviously delicious too, although I didn't try the locally raised turkey, which apparently costs way more than chicken because people around here don't really eat turkeys so much as use them as guard dogs. But the adventure of the day was jackfruit. Every morning, Steph and Jo and I sit and wait for the shuttle to Kisian under a jackfruit tree, and wonder what tragedy would occur if the fruit fell off the tree. We finally got up the nerve to ask the staff at the hotel whether we could have one, and they were nice enough to give us one for free (no one here eats them, although you can see them for sale in Uganda). We called it a baby and carried it around, letting it stink up the car while we ran some errands, and later on Ricky showed us how to prepare it. The slimy stickiness got everywhere and we made some of the fruit into smoothies but overall were unable to handle the sickly sweetness, but we did have fun shooting the seeds at each other. If it had been an unripe one, I would have tried this recipe...

Our jackfruit baby/small child

As for real Thanksgiving (on Thursday), I worked all day which was very eventful, since everyone goes on leave pretty early in December and therefore freaks out at the end of November about all the things that need to be done by the end of the year, for example transitioning the entire Human Morbidity Survey from PDAs to smartphones in 4 weeks… Also apparently in the Nairobi KEMRI/CDC office they take off both Kenyan and American holidays but here we only get Kenyan ones. Then I attended a potluck with lots of high ranking CDC and Walter Reed people, and the cultural differences between civilian and army health research organizations was glaringly obvious, so John the statistician decided that his next job should be writing an awkward style sitcom about CDC and Walter Reed employees in Kisumu. I'll let you know when it comes out.

World Rabies Day!

On Saturday I helped out with the World Rabies Day dog vaccination campaign - this was supposed to be held on September 28^th, but for various reasons was postponed. It was hectic, and crazy, and although my initial role was to ride around and visit the 9 vaccination sites and help out with coordination, at one particular site I got pulled into writing vaccination certificates. Obviously this was the best role for the Mzungu that speaks very minimal Luo, and I'm sure I ended up asking "Your name is dog?" over and over again. Oh well.

The important lesson to be learned from all of this is that people here give their dogs ridiculous names. The most common name seemed to be Michelle, with a Barack or two and a few Obamas. Second most common set of names included Annan and Mugabe, and there was also a good contingent of Osamas and Saddams. My favorite was Tuktuk. Naming a dog after a rattly motor rickshaw taxi seems like a great idea to me.

Okay so here are some pictures of puppies.

More can be found here:

2010-11-20 World Rabies Day

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.)!!!