Notes from the Field 2008

Well, with just under a week left in Kisumu I’m starting to think about what loose ends I have to wrap up. I would be dreaming if I thought I could touch all the things I have left on my to-do list so I’m thinking realistically and coming to terms with the fact that there will be things left undone. But that gives me reason to come back! Which I’m definitely thinking about doing already, before I’ve even left.
So, what have I been doing the past 2 months? I haven’t gone into very many details in my blog mostly because there are so many other exciting things to share and work just seems to fall to the bottom of my list after surviving white-water rafting, a short-course of ciprofloxacin, and slaughtering goats (more on that later).

The UMN project in Kisumu mostly needed my help sifting through data and filling gaps. Occasionally data collection on mosquito densities and rainfall was lapsing and papers are starting to depend on this data being much more accurate. I spent the majority of June shuffling through paper forms (all of which are scanned into the computer for data entry), re-organizing filing systems, finding duplicate entomology records, and then shuttling dubious forms back-and-forth from the field for correction. The problems seem to be resolved now, for the most part – the rainfall conundrum still eludes me. But I’ve gained a newfound respect for good organizational skills and file cabinets!

My preceptor and I have also discovered the necessity for naming files. My supervisor at the U is good about insisting on proper filing syntax, but this teaching has failed to be instilled In Kenya so we end up with 4 files named “filterpaper samples round 4�. Bit by bit, though, things seem to be getting better, at least for the time being.

I have also been trying to finish several manuscripts on the analysis that I have been doing both here and at home. The task is daunting, but do-able. I’m resigning myself to weekends spent at the pool with my pseudo-working laptop writing feverishly (well, it’s more like writing and then DELETING feverishly, but you get the point). I had been good at setting deadlines like, the intros will be done on Saturday, and then I’ve been even better about missing them. Somehow the Kenyan mentality of “slower is always better� has permeated my existence.

My preceptor (who moved to Kenya not two weeks before I arrived) has also started to live the “Kenyan� way. We tend to roll into work at a leisurely 10am most mornings. We take a long lunch, enjoying the company at the canteen (and counting buggy beans) and the wonderful fresh air.

Another example of the “Kenyan� way: Fridays are known here as “Member’s Day� – officially meaning that members of the various supper clubs around town leave work around 4pm to gather for drinks and then a lavish dinner. Unofficially, this means that everyone – member or not – tends to start packing up their things by 3pm and then trickle out of the office so the boss-man doesn’t notice. In fact, the CDC shuttle (notorious for it’s 7:30am to 5:30pm work day) even observes this leaving at 4:30pm on Fridays, if not 4:15pm if the riders are ready.

But seriously, we have been working very hard the past few weeks and I think the “accomplishment� list is a few lines longer than the final “to-do� list, which is gratifying. I’ve learned so much about the practicalities of doing epi research. Like, when it rains in Africa you better not expect anyone in the field to get anything done…because there is absolutely no way that the roads are passable. Or that explaining a procedure or a method once is never enough…concepts take time to grasp and we should all be patient enough to ensure everyone knows what they are doing. And another, never assume anyone knows exactly what they should be doing or knows exactly what is going on. These issues are as much cultural as they are human…so expect them everywhere.

Posted at 08:08 AM | Permalink | Comments (0)

So today my preceptor, friends, and I stretched our epi muscles at the canteen. The canteen is right in the middle of country club-esque CDC campus and is likely the cheapest place in Kisumu to find some grub. And grubs we have found!

About 3 weeks ago I discovered a bean with holes. Not ever seeing this before I inquired of my veteran friends. "It's a bug, just pick it out" A what! A bug in my bean? Ok, so my friend took her spoon and proceeded to smash the bean until she found the little black devil. Since then I've become only slightly OCD about checking my daily bowl of beans. At times I've had a killing, nearly 20 beans deserted from my plate for fear of bugs.

I guess I've related this story to several of the students here, much to their chagrin. So, today I was informing my preceptor of the buggy bean syndrome. Sure enough, he had quite a few. So, we decided to test our "eye-ball" evaluations. We took several of what we thought were positives for buggy-ness...100% bugged (true-positives)! Next we took what we thought were some negatives...100% non-bugged (true-negatives). Finally came the true test: the indeterminate. My eye said "bug!" but 3 of 4 felt otherwise. Low and behold we found a bug! I forgot to count our trials before the plates were cleared but my eye was truly 100% specific & 100% sensitive, not too shabby.

It's at this point that I hang my head in shame...I have officially become an epi nerd:) But at least I'm bug-free!

Posted at 12:23 PM | Permalink | Comments (0)

No it’s a theme park or even an urban legend. Nope it’s a class 5 rapid on the Nile River!

A big group of us decided to head to Jinja, Uganda for the weekend to have our luck at white-water rafting. The trip from Kisumu took about 5 hours via coach bus, so we were there in no time. However, the buses here don’t usually stop at a station or well-marked designated area. No, they just let you off. I guess we were lucky to be dropped off at a gas station on the out-skirts of Jinja. The guy before us, happily, got off in between two trees on some random stretch of road. So we hitch a couple motorbikes, bombarded by a mob of bikes is more realistic, and headed to the campground/dorm that the rafting company keeps for guests.

The adventure started as soon as my friend and I heard a grinding noise coming from the depths of the bike. I clung tighter to Hillary and said a quiet prayer as I noticed us start to pick up speed down the dirt road into the camp. I had the fleeting suspicion that our driver was in a weird gear, but I know nothing about gears and transmission so I didn’t yell a thing at him. I should have wised up and told him to slow as I could just barely see more rocks and a monstrous speed bump at the entrance to the camp. But we went straight for it and flew around the corner…me feet and Hillary’s fly off the foot rests unable to maintain their cramped position as this insane speed and the lift we caught off the bump. The only thing that stopped us from barreling into the fence was the driver’s heels, which he had wrenched into the ground like Indiana Jones. Once we stopped I think I just sat there for a while not even realizing what had just happened until I heard our other friends run towards us speechless. All I could say to the driver was “are your brakes bad?�. He just laughed, oh yes that was fun.

Wow, so the adrenaline was peaked Friday night and again on Saturday as we began to get ready for rafting. The lodge/camp where we stayed is owned by the rafting company and has a full service kitchen with bar service. The bar and eating rooms are open and look out from a cliff onto the very beginning of the great Nile River. The Nile is suspected to begin Lake Victoria, though this may be questioned soon according to the owner of the company. I’m not sure if all rivers are like this, pretty sure the Mississippi isn’t, but the Nile begins really rocky and turbulent then simmers are it reaches north. So, this is prime country for some massive rapids. There are several classes that rapids are grouped into and class 5 is the highest class that is commercially navigable and there are several class 5 rapids that the company rafts within 25km of the campsite. They have a picture of a raft (which I had seen this the night before) flipping on one of these class 5 rapids (the “bad place� actually) and it’s literally on it’s nose with some person just hanging from it about to plummet into the froth beneath. Crazy…what kind of psycho-weirdo does this for fun?! Well, I guess I had signed up for that. The manager was asking us if we’d like to take the mild or wild lines down the river. Turns out that there are several ways to traverse each rapid and so I had to make a decision but peer pressure got the best of me and I fell in line with the wild folks.

We set off around noon with our Brazilian rafting guide (he just travels around the world guiding rafting expeditions, typically stays in one place about 6 months to get to know the locals and then moves on to his next adventure…pretty amazing!). We got lessons about paddling, flipping the raft, how to “GET DOWN!� during a rapid. The guide shouts all the commands to the 9 of us in the rafts and we promptly comply…no questions asked. He may look like Capt’n Jack Sparrow (no joke;)) and may have completely lost his mind but, heck, I trust this man with my live during every rapid.

Practicing flipping was about the scariest thing I think I’ve ever done. All 9 of us piled on one side of the raft and then all of a sudden he just flipped us over. Some of my friends were able to reach the air pockets that the raft makes with the water. I just wanted to the surface wherever that may be. But always keep hold of the boat & your oar!

So, with less than 30 minutes of instruction we were off. First we hit a class 2, pretty tame and no getting down this time.

Then we hit a class 4! Ok, this felt freaky. It was exhilarating. We got down, I think I fell on someone, but I got down. And then 2 seconds and a mouthful of Nile later we were back up paddling and hooping like champions. Our excitement waned as we found out that it was only a class 4 and it was an easy one. There were 4 class 5 rapids to attack and they were going to be hard. “Donald Duck� was first with its low-hanging branches, then “Silverback� that was the most challenging of the day. Then “Bujagali Falls� where we were to be plummeting off a 12ft waterfall and last but not least, the “Bad Place� where, if we flipped, we were likely to be underwater for a good 20 minutes and swimming for a long time.

Ok, so my heart was racing and I almost spouted some swear words, but take it in stride. So, we hit “Donald Duck� with a vengeance and made it safely down. It was a rush. You can see the end of the water just as it crests over a small fall in the ground. Then all of a sudden you’re then and there’s nothing you can do but GET DOWN and hope to god that the Brazilian man is good. Once we were through we all yelped and it was the greatest feeling…fear gone and you’re just enjoying the ferocity of nature. Not all the rafts were than lucky; one raft lost a few oars, but recovered well.

Silverback was another story and oddly it was swarming with bats. The tree tops just had circles of them. Of course all of us public health nerds immediately hated turning down that rabies vaccine offer and then frantically began to worry about Marburg and how close we thought the bats might get (worry warts). We, thanks to the Brazilian, made it through the rapid unscathed, though. And we were almost always the first boat through the rapid so we sat and watched the other boats come down. The safety kayakers were really keen on this rapid and thank goodness because the next boat that came down throw 4 people high into the air as it took the rapid on sideways (the easiest way to flip a raft). We were also there to take in the drenched stragglers. They were fine…most of us were there for the adrenaline rush and to get wet so we didn’t mind. The next two boats slipped, but everyone was ok.

And so the day continued. We hit some smooth water so relaxed for a long while and told really bad public health jokes and analyzed every factoid we’d heard from the day. Our guide was so confused why we were so concerned with the math errors on the anniversary life vests we were wearing or why we kept talking about schistosomiasis so much… oh, or why I kept asking him what it felt like to have malaria and what kind of meds he was on (he had just come down with malaria not 7 days before our trip). We’re a fun bunch☺

So, we were relaxed enjoying ourselves when we started to suit up for the next rapids. Nothing to worry about we were told, no problems this was just a little rapid, just a class 3. We get there and I didn’t think anything of it until we were going sideways and my side of the raft was in the air flipping over into the rushing waves. Boom! We were in. I grabbed on for my life and fought my way to the surface. Still had a hold of my oar and the boat when I came up, thank goodness. Our guide was on the top of the boat to flip it back over, but he had this urgency about him. He flipped it, we scrambled back to the surface and then he was throwing us back into the boat…because not 5 seconds later we were about to hit another rapid, smaller this time, but still big enough to GET DOWN! Man, talk about a hustle and a rush. All in all, everyone was fine. There were a few lost oars and a few missing persons who were picked up by the other boats, but we had survived.

The “Bad Place� was the only rapid left of the day and just after our flip, where we were maybe under the water all of 8 seconds, only a few of the guys and my dear Hillary had the desire to be stuck under the water for 20 minutes! Our chance of flipping was slim if we took the right line but we could easily miss and then get stuck in the “Bad Place�. The rapid leading into the “Bad Place� was visually a class 6 or 7… massive! So, we walked down most of it and just ogled at its enormity. We reentered the boats and I was in a “bad� shape! How the heck were we going to do this? The waves were massive and the river was huge at this point, there seemed like no way that we’d be able to paddle enough to get the line we needed to stay up right. But I got in and off we went paddling, paddling until my shoulder just burned. Then all of a sudden “GET DOWN!�. One massive wave hit, I thought we were doomed, but we kept going and then that was it. It was over…what? It felt like nothing compared to Silverback or even Bujagali Falls. I’m sure it was hype but my gosh that’s some good hype.

Wow, it was the greatest thrill of my life. I wish I had photos! Amazing. So, if you’re ever in Uganda or nearby jump on the Nile. It’s fierce, full of schisto and malaria, but impressive beyond words. So far the absolute highlight of my trip!

Posted at 03:06 PM | Permalink | Comments (0)

I went on safari this past weekend in the Masai Mara game reserve in southern Kenya. It was so phenomenal. Three of the new friends that I’ve made came with me. We hired a spectacular company called Wild Connections Safaris to take around the reserve. They picked us in Kisumu and 9 hours later we were watching a herd of 11 male giraffes try to court and mate with 2 female giraffes! Incredible!

Our guide (Isaac) has been guiding safaris for 15 years now and his colleague is a British professional photographer (Paul). Isaac and Paul started the company about 4 years ago and take people to see wildlife all over Kenya. Paul had brought along 2 spectacular cameras (which one of my friends got to use the whole weekend, jealous!) and so was primed to see the lion pride that he and Isaac have been tracking for years. I was a little suspicious that we would have enough luck to see one lion let alone the 11 that we did end up seeing! There were three bachelor lions who had yet to find their own pride but we were able to see Paul’s pride…including the 2 new cubs that were probably just a few months old.

Lions are among the big 5 game animals that are notorious in the Masai Mara and Serengeti in Tanzania. Water buffalo, elephants, leopards and the black rhino make up the other 4. They’re called the big 5 because they fetch the greatest price at market and are the hardest animals in the savannahs to hunt on foot. Unfortunately the leopards and the black rhinos eluded us all weekend, but seeing as there are only about 16 rhinos in the whole reserve and less than 100 leopards it wasn’t likely that we’d fill our big 5 card up.

But I do believe that Isaac, Paul, and our driver, Sammy, were the best safari guides in the whole of Kenya (if not Africa!). Combined they know just about every species of mammal, bird, reptile, plant, and insect that can be found in the Mara. I learned so much about animal behavior and the eco-system of the Mara…we even had periodic self-prompted quizzes on our way through the park. Most safari guides rely on park-wide radios to see where and when other drivers have spotted some of the elusive animals. But not Sammy! Lord no, Sammy and Isaac just use their eyes and ears. If we’d see a flock of circling vultures we’d head their way to see what the kill had been. Or, as happened, Isaac would see something dip below the grass and say, “Look, and ostrich incubating her eggs!�. Then we’d all squint and strain our eyes to see nothing until we were right beside the nest! Seriously, this is one fantastic guide if he can see an ostrich head about a mile away in tall brown grass.

And these stories continued with all the animals we spotted. Jackal, hyena, crocodile, hippos, baboons, owls, lilac-breasted birds, vultures, wildebeest, caracal, giraffes, elephants, cheetah, water buffalo, vervette monkeys, safari ants, termites and their massive hills, Egyptian geese, and the list goes on and on.

By the end of the weekend my butt and torso were bruised from the bumpy car rides/game drives, my liver was spoiled by the gallons of Tusker that it felt like we had consumed, and my 1GB of photo memory was completely exhausted. We made it back to Kisumu late on Sunday and we all dreaded going back to work and facing real life. But I’m back and trying to soak up as much as I can in my last 2 weeks here.

If you ever get the chance to go on safari do it! Amazing!

Posted at 01:44 PM | Permalink | Comments (0)

It’s been a rough couple of days in Kisumu. The rainy season is in full swing so I’m beginning to get used to the daily 30-minute threat of rain at 4pm. And I’ve thrice now almost fallen though the gaping holes in the sidewalks that leave the sewage drains now open to the public nose and the unassuming white person.

It has also be a rough couple of days for the project. Everything is going as scheduled, in fact we’ve consented more than enough participants for the next round of the study. Our field assistants have responded above and beyond the call of duty…truly the shining stars of the project. However, we’ve been faced with frustration from the villages because of “unmet promises�.

Today a field assistant told us a story about a person who is now refusing to participate because he feels we are not helping him or his community. This is the absolute last thing any health professional and public health researcher wants to hear and it broke my heart. It frustrates me to the core that we only have funds enough to provide the clinic with anti-malarials. I want to weep by the fact that our clinical officer has no means to collect and test a simple stool sample.

Our sites have been so lucky recently…the Kenyan Ministry of Health has begun an extensive indoor residual spraying (IRS) campaign, which is likely to effectively wipe out the mosquito vectors and reduce malaria transmission to null. Our talented assistants thought, well heck, if malaria’s gone then can’t we use the money for treating typhoid? If only it were that simple.

And I’ve been struggling today with why I’m not asking “why isn’t it that simple?�. I have never felt more powerless than I did today having to explain that our funding source restrains us from being able to provide all the medicines that one community may need. All we can ever promise these people is free anti-malarials and a trained clinical officer who is able to refer you to the district level if she’s unable to treat you. While that means a lot to the vast majority of the population in our sites it’s vastly disappointing to see so many people fall through the gaps.

Today I feel like I’ve seen the dire nature of the majority of this world and a prime example of where I fear we have failed. The clinical officer was examining a girl when I arrived. The child was struggling for breath and her nodes were so tender she shuttered every time the officer touched them; yet there were no medications in the clinic to help her, they had run out. The trip to the Kapsabet district hospital (where the girl was probably referred to) is a long 45-minute drive down pitted and washboard dirt roads. The girl would need to hail a bicycle for the trip seeing as our car is usually the only one on the road.

I understand the reality of choosing your battles but it feels so dissatisfying right now.
This is not a new feeling for me…after reading passionate books by Paul Farmer, watching a documentary about clean water in class, or hearing a lecture on the sad role social structures play in determining health I always struggle with how to eliminate the issues while still being practical. I feel so bound by the limits of funding and the public health urge to be overly practical.

Posted at 07:46 PM | Permalink | Comments (0)

I haven’t really written much about public health since I started. I’ve been so enamored with the culture and my surroundings that I’ve kind of forgotten to let you in on the public health observations that I’ve been making. There have been several that I’ve been brewing about, trying to synthesize why I feel the way I do and why I see them as issues. I don't think I've come to many conclusions yet but I have about 4 musings…

#1: On the long drive to the field the site supervisors and I tend to chat about certain public health concerns that are on my mind. It started with bednets. There’s one on my bed, for certain, but is there one on anyone else’s? In the highlands they sometimes offer free nets (ie. on World Malaria Day or some other holidays). Other times the nets are just 50Ksh (about $0.75). I’m not sure how much income is generated in the highlands but it’s well known that a lot of people “cannot afford� this. The health officer disagrees and often sees men who have just refused buying a net out drinking 80Ksh Tusker beer. Other times the health officers see brand new blue, mesh curtains in huts windows…hey I guess they can still keep the mosquitoes out but we would prefer to see them covering the children! What’s to be done? There are very few mosquitoes in the region except just after the rains so there may be no perceived threat. Yet, 75% of families are likely to see malaria at least once every five years or so… hmmmm. I’ll keep pondering how to get to the nets on the beds.

#2: There are also two Voluntary Counseling and Testing (VCT) centers for HIV in nearby Kapsabet. They sit right on the main road with doors to the street. Now, in a place where HIV is so stigmatized this doesn’t seem to make much sense. Yes, give them access; yes, provide services; yes, let everyone know you’re being tested and become an example! But that takes one gutsy person. So, I’ve been asking about it. Do people actually use these services? “Sometimes�, was the answer. So I probed further. Why only sometimes? HIV is mostly found on the coast of Kenya, near Mombasa they say. It’s not as common in Kisumu, but there was a very high profile male circumcision study for the prevention of HIV so it must be present. However, my supervisors speculated that many people in the highlands are likely unaware of HIV both as a condition and as a disease that they should be concerned about. Another thing I would like to probe the Ministry of Health about.

#3: One of the data entry men (I call them the Frat boys…) came in late today because he was donating blood for a friend. His friend has been sick for quite a while and needed around 3 pints of blood. My colleague was able to give one, as was one of the friend’s relatives. But they were still waiting for a third donor. Most hospitals don’t stock blood supplies and rely heavily on relatives or friends like this with matching blood types to help out in a pinch. My colleague was saying that he knows many who fear giving blood because they will need to be tested for things like hepatitis (of all subtypes), HIV, malaria, and a whole host of other blood-borne pathogens. He thought that was why they were unable to get a third donor. This got me thinking about all the other things in medicine we so often take for granted, not just the US blood supply.

#4: We take for granted a lot of things that are outside our health system that are public health oriented… our mosquitoes are so friendly back home. The same colleague who gave blood asked if we even had mosquitoes since we don’t have malaria. Nope, we don’t sleep under bednets either… I have been surprised by the vast number of non-pregnant adult women and men sleep under bednets on a continuous basis in Kisumu. It may be the biased sample size I’m taking…after all I’ve only really been talking to be people who have some sort of connection to our malaria project or the other CDC/public health affiliates that populate this town.

#5 (I guess there were more than 4…opps): It may be the education people are receiving. Kisumu has one of the highest literacy and education rates in Kenya. Even the boda-boda drivers have diplomas. Unfortunately, the unemployment rate in Kenya is staggeringly high (40%) and very high in Kisumu compared to other districts. These people are dang educated. They know their stuff and know what’s good for them. Yet, there are still many that we need to get our message to.

#6 (last one, I promise): I do see ads on tv for Supanets bednets and for antibacterial Dettol soap (yes, the ads show a child glowing in a green halo who has just emerged from a Dettol bath – perhaps an antibiotic resistance nightmare, but good nonetheless). There are public service announcements from UNICEF about the ongoing cholera outbreak in Kisumu (they drive in their marked Land Cruisers to the far reaches of rural Kisumu with loud speakers bungeed to the roof) and PSAs about Staph aureus and meningitis (though this one might have been slightly confusing because they went from N. meningitidis to N. gonorrheae in the same sentence without really explaining the difference).

And I could go on and on, but we’d lose readership. Needless to say it's a different place with much different dilemmas than we often are faced with in America. And things are getting done. It's amazing that free nets and VCT centers even exist. But there's always proof that so much more is needed. I'm so thankful that I've been able to be here to see and reaffirm the presence of these issues and to begin to think of solutions.

UNICEF truck at Dunga Beach advertising current cholera outbreak in the Kisumu area. I hear this happens a lot... Or rather that there’s this constant underlying cholera problem that the city, which by the way sits on the 2nd largest fresh water lake in the world, faces due to the "lack of clean water."

Posted at 07:33 PM | Permalink | Comments (0)

So, I'm just sitting in the upstairs lounge of my hotel enjoying the view over the lake and a nice COLD Tuskers beer (you must specify the "coldness" of your beer or else you might get it warm...like the Kenyans take it). The windows are open and a nice breeze is cooling me off from the warm, dusty ride back from the field. I was hearing some commotion so I moved closer to the windows. I realized that what I was hearing was Indian music. WHAT? I'm in Kenya!

There's actually a very large Indian population in Kisumu, and I think Kenya as a whole. Upon my arrival I was told that sometimes the Indian food is the cheapest and safest bet in town... In fact, Chapati bread is just as much a mainstay in the Kisumu/Luo food vocabulary as it probably is in India.

Anyway, so there was this enormous parade with 4 cars, three chunks or dancing people and a well-lit chariot. I asked the waiter if he knew what was going on. He's Kenyan, so that was likely a dumb question but I had to ask. He thought it was maybe a wedding...I can see the fury on the mutatu drivers' faces and the angst slowly building in the boda-boda drivers. I can't believe that this type of parade happens each time there is a Hindu wedding...the Kenyans wouldn't stand for it...they're too impatient to have their roads blocked like this for even just 15 minutes (the entire time it took the parade to pass by the hotel and turn off the main road).

As they came closer I realized that the flags said "Chariot Festival" and I noticed the lit chariot had, not people, but maybe statues of the deities involved in this festival. Very cool. Very bizarre to see in Kisumu, but very cool!

Now I feel like a nice hot chicken curry...yum!

Posted at 04:22 PM | Permalink | Comments (0)

Wednesday, a conference call with the lab back home keep us at KEMRI until after nightfall. It was only 7pm (not late by any standards) but the night was as black as ever. The sun starts to set around 6:30pm and rises only a full 12 hours later. It’s quite a shock from the 10pm sunset I’ve grown used to during the Midwestern summers. It seems to slight my evening activities because I not keen on wandering around alone, or at all, at night here.
Last night on the way home I realized how many people are still out and about beyond sunset. The little villages we pass on the way from KEMRI back into Kisumu were all lit by kerosene lamps and little burning piles of trash. People were congregating around the little shops as they tend to do and it was business as usual. The boda-bodas were still on the road…but very few have lights or reflective material. It felt slightly like driving through Yellowstone at night. You’re driving and then all of a sudden you’re seeing an object in your headlights. There’s a sort of thickness to the darkness here. The lack of streetlights and the cloud cover of the rainy season (which seems to have just started yesterday) really seals into the night. Right now I look out over the main streets of downtown and see nothing besides the faint glow from a clock tower and the 4 or 5 cars that still linger on the streets. Amazing, almost, how peaceful and quiet Kisumu becomes at night – stark contrast to the bustle of the daytime.
Speaking of bustle, today I got off a little earlier and needed to get some peanut butter…I’ve sadly already exhausted my supply. It was still light out and I felt like an adventure so I called over a boda-boda. The man winked (ugh) then I climbed on the back and literally sad a prayer. I’ve seen how close those mutatus and trucks come to the bikes so I knew I was in for a close ride. I realized, about 2 seconds into the ride, that the boda-boda I’d caught had makeshift handles… Ok, so these are basically uni-gear bikes with a cushioned rack on the back with additional passenger handles welded underneath the driver’s seat. Some boda-bodas are posh-er than others with rubber grips provided a comfortable hold for the passenger. Mine had little bitty metal loops for me to grab! Think two metal toothbrush handles! Got it?! I was white knuckling the whole way. You hit a bump and feel a few G’s in your stomach as you come on down.
Alas, the maybe 10-minute ride came to an end, just a few round-abouts down the road from my hotel. Looking back it’s not much of an adventure, but after all the injury stories I’ve heard and the accident mortality ratios that are flashing before my eyes I’d have to say that I’m pretty proud of my boda-boda ride!
Happily, I took another one back to the hotel – this one was much nicer…I should have gotten his cell number and he could have become my regular driver. I kind of wish I someone had captured my Kodak moment…hmmm, maybe next time.

Posted at 07:41 PM | Permalink | Comments (0)

I’ve been in Kisumu for just under 2 weeks now and I had yet to find the vegetable market until just yesterday…sad. My mouth began to drool over the glorious potatoes, carrots, zucchini, lettuce, passion fruits, mangos, pineapples, and bright red tomatoes (though I can do without the latter). I wanted everything in sight. And here there are gobs of choices about whom you buy from. The produce is situated under a massive barn structure that is packed. It sort of reminded me of the cattle barn at the State Fair…how all the cow stalls are just crammed together and you walk along the narrow aisles. And the state fair continued outside with the masses of chicken cages. I saw a man who had probably a dozen live chickens just tied to the handles of his bike…I rue the day bird flu hits this place. My friend and I dodged some turkeys and geese to find several jewelry and fabric stalls. Apparently, if you bring in fabric the women who run the stalls will sew just about anything for you. I have always wondered where the women buy their beautiful dresses and skirts…this is the place!

KEMRI -- This is the place where I work day-to-day...closely
resembles a very nice country club.

My friends and I ended out the day being ushered into a nightclub. It was 9pm (so a decently late hour) yet we were the only souls around. It was nice and new inside so we wondered when the crowds came. Dinners here are typically taken between 8 and 10pm…so we knew we were early. But by 10:30pm, with only a handful more people and ringing ears from the blaring party mix of Cher, Shakira (oh, they love her here;)), Enrique, and Celine Dion, we decided to call it a night.

Today I was invited to join a bunch of ex-pats (other mzungus) on a hike in a few of the hills surrounding Kisumu. I jumped at the opportunity to get some fresh, non-Kisumu air and some exercise. It was also a great chance for me to meet some of the other Americans who live and work here. I have a strange, small-world connection with my supervisor’s wife so it was nice to catch up with her and see how her transition to African life was going (very well, I’m assured). Among the others who were also on the hike was none other than a 2001 U of M SPH grad. Amy was a Judd Fellow way back when and did some research/field experience in Tanzania. We talked a little bit about SPH and how much she worked to get more infectious disease faculty on board (for that I am eternally grateful…bless all their hearts). It was surreal, almost, to randomly run into Amy and her husband who have spent considerable time in MSP. And, low and behold, Amy is a great friend with my mentor through the Alumni mentorship program. And, if I hadn’t thought I was networking enough, the other woman we were with works for the CDC and is actually a great friend to Amy’s mentor while at the U of M – hence how they know each other! What little we naïve students know about the power of a mentor and his/her network…amazing.

Kapsisiywa -- This is one of our field sites. The picture was
taken directly across the street from the health clinic.

It turned out to be an adventure of a day. We took several wrong forks in the trail and had to continually convince our 3-year old traveler (the very sweet daughter of one of the party) that she could climb the boulders and blaze her own trail. Several thorn-induced scratches and slippery slopes later we rested for lunch. We had ended up about 20ft from the trail we should have been on so found it quickly and tried to track where we should have turned as we headed back to the car. The trail was to end somewhere near the source of a spring waterfall, which sounded sublime. But the vistas we saw and our proximity to the waterfall the whole time was likely comparable. Western Kenya is truly beautiful country. I often heard people say it’s their favorite African country…I’m a believer!

Kipsamoite -- This is the second field site. Again, the photo was
taken across the street from the health clinic. Kipsamoite feels much
more open than Kapsisiywa...much less tree cover and more crop fields.

Posted at 04:48 PM | Permalink | Comments (0)

It has been a while since I’ve written and I have a lot to catch you up on. Pole (so sorry)!

I have now been to several parts of Kisumu:
Dunga Beach – a fishing village where you can buy and fry catfish, tilapia, Nile perch, and sardines. We met some very nice locals who took us on a boat ride and conversed about dowrys, illness, and Barack Obama (of course☺).
Milimani – the Edina of Kisumu, where there are palatial mansions and where the majority of Mzungu (white people) live.
Tuskys – a Target-like shop with a hopping bar next door where Kenyans tend to consume way too much Tusker beer and Guinness – of all things (the 2 Irish girls I’ve met are absolutely disgusted by the thought of Guinness in a bottle, so they get a kick out of the Kenyan drinking habits).
Kiboko Bay resort – a lakeside resort just south of Kisumu on your way to Dunga Beach, the resort is nestled near a hippo territory so there is excellent hippo viewing (from a great distance, thank goodness. They can be very angry, vicious creatures).

I have also been into the field two times. Last Thursday I accompanied our lab supervisor into the Nandi Hills. They are the most beautiful land I have ever seen, so lush with tea estates and sugar plantations. One sugar plantation hosts the nicest school I’ve seen in Kenya so far (the company must be doing very well). There is also an endless amount of corn/maize, soybeans, and cattle. Sometimes I almost feel like I’m back home on the farm, except for the enormous hills and random palms and succulents spotting the hillside.

Last week we dropped off the consent forms and followed the field assistants to several households to supervise the consent process. The mother or father typically greeted us with a very warm handshake and then led us to makeshift benches outside their stucco/mud huts. The cattle were typically around and the goats, malnourished dogs, and chickens were darting among and around us as well. The field assistant begins the consent process by explaining the form – generally the form is read to the participant rather than simply handed over. Of the few that I saw none of the participants were consented in English but, rather, preferred their local Nandi language, though we provide forms in English and Kiswahili as well.

Yesterday, I spent the day in the field, again, but this time collecting and verifying the completeness of the consent forms. The field assistants, being in their hometown, tend to know everyone so it’s imperative that we’re sure that the study id number matches each specific person. Tedious but essential. There has been some unlikely confusion in filling out the consent forms…most likely because of the language barrier or wanting to complete the forms too quickly. It’s been definitely worth my time to be involved in the consenting…we tend to quickly learn what is needed for IRB approval but don’t ever get a feel for the nuances of actually gaining someone’s consent.

Beyond that, I’ve been falling in love with Kenya. The people here giggle (they don’t laugh, they all giggle like school girls – even the grown men!) and seem to always respect your wishes (even the pushy boda-boda bike taxis). I’m vastly enamored with the enormity of children that are here. Unfortunately, the country’s under-5 mortality rate (121 per thousand) is such that many won’t live much longer. But they always smile at me and yell “How are you?�. It’s the only English they know but they love to hear the response “fine� to know that they’ve got it right. My new name is truly becoming mzungu to the gobs of kids in the hills.

Posted at 10:42 AM | Permalink | Comments (0)

Karibo Kenya (Welcome to Kenya)! I'm finally here and loving it! I've been planning for and dreaming of this trip for such a long time now that I can't believe I'm finally here. Wow!

I landed in Nairobi two days ago, spent the night and then traveled to Kisumu to get to work. I was met by our American supervisor and two of the Kenyan field supervisors. Getting off the plane though, I saw a swarm of people jetting towards a woman who had been sitting just in front of me on the trip from Nairobi. At the head of her welcome party was a man in a suit with a gold medallion around his neck (the mayor of Kisumu). There were some cameras and lots of hand shaking and welcomes in Kiswahili. Turns out that she's the Minister of Water in Kenya and had come to Kisumu for some meetings. Quite the pomp and circumstance, but she was very welcomed.

I have felt just as welcomed...everyone I have met has taken my hand and greeted me with a smile. Even though they are crammed into busy markets and dusty buses all the time, they are still so happy.

I don't have any pictures yet to share with you but I will very soon 'coz you've got to see the streets here in Kisumu. They are barely two lanes and a least half of each lane seems to be occupied by bota-bota (bike taxis). They're not like rickshaws at all; on the bota-bota you sit on a cushion or metal rack that's been welded to the back wheel. There is a bar for your feet and then a bar just under the driver's seat if you're new to the journey. (I have yet to ride one... perhaps I'll get brave enough later this week.) Cars and trucks then dodge the bikes and pedestrians, swerving into oncoming traffic and then quickly passing the slower hauling trucks. The matatu city buses also zoom by with a small cardboard sign showing where they’re going and then jammed with people. The lab has a driver, Silas, who carts us to and from work and the field. The supervisor noted that he’d never seen Silas drive so slow (we were probably going 60 km/h on the road to Kisumu town). I think Silas is trying to ease me in to the culture;) Asante sana, Silas (thank you very much).

But it took little else to ease me into the culture…right away I bought a cell phone and a Safaricom phone card. Not everyone has clean water but by-golly everyone’s got a cell phone! The “Target-esque� market is just down the road from me. There I can get the staples like bread, eggs, rice and beans but I can also get Dasani water, Suave hair products, and boxed wine! I think I’m set.

I head out into the field tomorrow to help with study consent forms. We’re starting another stage of the cohort surveillance so consent is a must right now. I’ll be traveling with the two guys who met me at the airport and our driver. Turns out that one of the highland site supervisors is Barack Obama’s “first cousin�; he’s believable but may also be catching some of the glory;) Unfortunately I forgot to pack my buttons and banners. This may be a blessing; it might have started to look like the Kenyan campaign headquarters otherwise.

Posted at 10:56 AM | Permalink | Comments (0)

First, let me introduce myself. My name is Melissa and I'm an MPH candidate in epidemiology with a concentration in global health and interests in infectious diseases. I'll be heading to Kenya in a few days, June 15th, to help with a malaria research project in Kisumu.

The project is headed by a physician at the U, Dr. Chandy John, and is in collaboration with the Kenya Medical Research Institute (KEMRI) in Kisumu where I'll be stationed day-to-day. I have a graduate research assistantship with Dr. John, which is how I got connected with this experience. I've mostly been spending my year analyzing data from a different project in Uganda, but have been most intrigued by the epidemiologic processes and questions that are part of Dr. John's Kenya work. Needless to say, I’m looking forward to actually getting my hands dirty in all that data! Little bit of a stats nerd in that regard;)

The project is comprised of about 6000 people who live in two villages in the Nandi district. The district in just north of Kisumu in the highlands, which flank the Rift Valley. Because the villages are at higher altitudes they tend not to see malaria on a regular basis (aka, non-endemic… in epi speak). This is great from an overall health perspective but it does create some interesting situations of epidemic transmission and some interesting immunological responses. Malaria tends to cause what we call “waning immunity� in the endemic areas. So, people who live and breath around malaria all the time will acquire some immunity to the parasite, as they grow older (which is one of the reasons we tend to see malaria in children who are still picking up their immunity). Those who live in non-endemic settings (such as these two villages) never get the chance to acquire immunity, so it’s suspected that older people will get sick as well as the young and there might be some additional immunological characteristics that are different.

The cohort is composed of both active case surveillance (where surveys go out looking for people who might be sick) and passive surveillance (where case detection is conducted at a health clinic); the real meat of a long-term epi cohort. There are also periodic sitewide blood collections that occur in both villages for immunology questions the project is addressing. I am lucky enough to be in-country when one of these is slated to take place. I have this image of a massive circus every time I think about the "sitewide" collection...so I'll have to let you know if it’s truly that crazy.

But for now, until I’m on the ground and no longer have to imagine what’ll be like, I’m checking my packing list, getting last minute boxes in order (I’m also playing the role of currier for the lab…), gearing up for my first foray into the developing world, and (rightfully so, I think) freaking out just a tiny bit.

Hopefully, this blog will help you travel with me and at least give you a glimpse into the cultures and adventures that I’ll be a part of this summer. Good lord, it’ll be fun!

Cheers,
Melissa

Posted at 09:21 PM | Permalink | Comments (0)