Nairobi

I got off the bus at the round-about near Westlands—lucky for me, my fellow passenger Lillian, and witness to the accident, got off with me and was so kind to wait around with me until I was properly situated. Rachel met me a few minutes later with her mom’s car—an older, yet exquisitely maintained, Volvo sedan. She was also with her three year old son and nine year old daughter. Her son said nothing to me, her daughter spoke like an adult and was a lot of fun to talk to.

We went to Carnivore, along with a few other Hubert Fellows from Nairobi. I think the first time I had heard about this restaurant was on the Canadian show “Travel Travel” back when we used to only get one Canadian channel up in Montgomery Center.  And it had stuck in my head since then. I almost went there four years ago when I was on my way through Nairobi to go to Kampala but decided against it. I’m glad I waited because I don’t think it would be as much fun without friends to share the experience.

It’s huge; an entire campus onto itself. There’s the restaurant and a nightclub and even more that I didn’t get to explore. The restaurant is a flat fee—about $30 for all you can. If they included drinks, it would have been even better but still, great time. Basically, it’s sort of a five course meal. They bring you appetizers, soup, a salad (one small plate for all to share, but, eh, it’s called Carnivore for a reason), meat and then dessert. The apps and the soup, were the best part from a pure culinary perspective, they would have been good anywhere. The meat is spectacular because of what you’re eating and not really how it is prepared. Although the chicken sausages were really, really good.

A few years ago, Kenya passed a law which essentially removed some of the wild game from the menu: if you want zebra, gazelle, etc, you’ve got to go to the South African version of Carnivore. Still, I had enough meat to last me a while: chicken, pork, beef – pedestrian. But I ate a cow nut—not verbatim how it’s listed on the menu. I won’t go out of my way to eat it again. I also tasted crocodile, ostrich and camel—none which were terribly delicious or anything I’m going to seek out on a regular basis. But the experience is great. You have a flag in the middle of the table and the servers have the meat on skewers and just keep circulating throughout the restaurant to the tables with the flag up until you are completely stuffed with meat.

Next day, I met up with Brian (friend from med school and Nairobian—mnairobi) and moved to his family’s house for a few nights. Here I was treated to traditional Kenyan hospitality. I was welcomed into the family, served more food than I could ever eat and made to feel so comfortable. Brian also took me around the Central Business District (CBD) and showed me all sorts of sights including the Kenyatta International Conference Center (KICC) where we sweet talked the woman selling tickets with Swahili to give me a resident rate! And what a view from up on the top of the second tallest building in Nairobi. We saw Mt. Kenya and the Nairobi National Park and we also were looking into the national stadium when Kenya scored the winning goal over Angola to keep hope alive in the qualifiers for the African Cup.

On Sunday, we spent the morning at Church and then had a leisurely afternoon lunch at the local restaurant. We then went on a  big walk of their neighborhood and I got a chance to see Nairobi. And then for dinner, I can’t forget the meals—I was treated to some traditional Kamba dishes cooked to perfection, and, naturally, in gigantic portions. So many thanks to Brian, Faith, Dolly and Mama na Baba Kilonzo.

Out from Kisumu

I brought to East Africa my travel backpack and a small duffel bag, with the intention of over the course of my travels I would give (almost) everything away. I’m going to try and document throughout the course of this—the things I drop off and to whom.

I left Kisumu on Friday morning to go to Nairobi. Early on in the month, Orliani, the guard at my second home, had asked me for my shoes. And I had told him I would think about it. As I left the house, I dropped off a little package at his chair, with my leather dress shoes (this was their second trip to Africa), a few pairs of socks, and a pair of pants. He thanked me a few times and said how he was travelling home at the beginning of the next month and would bring me back a Masai bracelet. I told him I would not be returning and he said, “If it’s God’s plan we will meet again.”

The bus ride to Nairobi was awful and broken into two parts. The bus I was on had only 4 passengers and we left right on time. But 30 minutes into our trip, I hear a long blast on the horn, the brakes are put on lightly, and then the brakes are slammed on hard and we skid to a stop. Before the bus stops, there’s an unmistakable knock against the front of the bus. We had hit something. (This is a real story, and the way things are in life out here, before you read ahead, make sure you want to know this.)

Your guess is as good as mine—child, bicycle, car, goat, dog, hand cart, motorcycle, cow, anything really.

The rule of the road is to not get out of the car when you hit someone—you drive straight to the nearest police station because people are sometimes killed for hitting a person with a car, and then a mob strikes when the driver or passenger get out to help. I stayed on the bus, and then I saw a crowd gathering around the bus. And then I heard someone say it was a little school girl. And I saw the crowd was not threatening the driver who had stopped, and gotten out of the bus. I figured, I should get out and see if there is anything I may be able to do.

So I climb down the stairs to the road and I’m expecting to see a mangled body of a girl under the wheels of the car. But instead I see a six year old girl walking down the road, crying, with blood staining the left side of her dress and a huge skull fracture with at least 3cm of asymmetric “lump” in the left temporal / parietal area.

It would seem fortuitous that this accident occurred just outside of a clinic / hospital so a kind woman grabs the girl and takes her to see the clinical officer who is way out of his league here. Meanwhile, the bus driver and the conductor are laying down branches to warn cars of the accident scene and calling the police as well as their manager and insurance.

Five minutes later, I’m talking with some people in the crowd and they say the girl is back, that the clinical officer is not trained nor equipped to deal with this situation. So the girl and this woman are just standing on the side of the road waiting to take a bus to get to town so she can potentially have her life saved.

I look at the driver and this was a friendly man and a caring man, and I say “Turn the bus around and take her to the regional hospital NOW.” He says, “I’ll be charged with a crime if I move the bus.” I yelled at him that the priority here isn’t your life, but her life and if she dies, he’ll have a whole lot more trouble. He just walked away at that moment.

So I sent someone to get the girl’s family, told the woman to sit in the shade with the girl and talk to her, and I stood in the road and stopped the first car that came by—a few cars went right on past despite seeing an accident scene and a bloodly little girl. Eventually a matatu came to stop—it was packed and couldn’t take her, but at least now I had faith someone would stop. The next vehicle was a pick-up, I waved it down (and stood in front of it) and it pulled off to the side. The woman with the girl, and a few of her colleagues, knew what to do—they jumped in, and braced her, and told them to the hospital as quickly as possible.

She was alert, speaking appropriately and had reactive pupils ten minutes after the accident but she had been hit hard by the bus. She was about 30 minutes out from the hospital and then who knows how long before she would be evaluated by someone competent. I can only hope for her.

Work Wrap-up

I spent my last Monday (March 21) in the field—my first trip out to Lwak since week one. I went with Godfrey (Deputy IEIP branch manager and my immediate boss) and we were tasked to meet with George (head of the field teams) and Peter (head clinical officer), the two gentlemen who will be tasked with implementing the strategies which we had developed over the past two months. The meetings went very well and we covered all of the details we needed—thankfully, everything that was planned was deemed possible and the few issues that arose were addressed on the spot and reworked to function better in the IEIP field and hospital systems. This was a successful day, and part one of my hand-off process. I needed to make sure the field teams agreed with the new algorithm and process and had all their concerns properly answered.

Tuesday, the woman whose job I had been doing while she was on maternity leave, came back to take her job over. Talk about good timing. She and I sat for about 6 hours as I went over and over all the thought and work which had been done in her absence. She grasped the scope of the changes we had made and was verbally appreciative for my work. We repeated a few of the key components and I handed her my to-do list—which was getting longer by the day. She had a few questions, I answered them and that was it. Half of my project was successfully out of my hands.

Wednesday was the big day. This was the day that we flew the woman out from Nairobi who was not on maternity leave, but whose job I had also been…assisting with for two months. Essentially, we had been making rapid changes to the protocols in Kisumu and she was isolated out in Nairobi without much of a clue (and didn’t seem to mind or have much interest in learning what was new—this is really what is worrisome).  And so she arrived.

I sat down with her and my other coordinator (who I had worked with yesterday) and I reviewed essentially all the same information. I explained the raw data, the projections and the budget—except with a focus on Nairobi (Kibera – name of the area). I got a lot of attitude from her most of the time, although attitude here is not what we think of in the US, it is way, way more passive aggressive. “If you say so,” “That’s acceptable, I guess,” “I wouldn’t have done it that way,” “But what about…” and other ways of just slowing down the process. Look, you just made about $3000 over the past two months and never showed any interest in developing changes. Eventually, after working through a lot, and helping her to vocalize her real problems with both me and my two bosses, I think we got on the same page, and I think she’s going to do a fine job here.

She stuck around on Thursday, an additional day, after learning how much work had been done and how far behind in comprehension she was currently. I worked with her for a few more hours and we got together a little more and started to understand one another. It was an exercise in patience.

And that was the end. I arrived in February and was given a concept and a working draft of an algorithm. I learned the IEIP system of interviews, clinic visits and data collection, I researched and learned about the principles of TB surveillance, I sorted through raw data, I worked on the computer (a lot), I churned out projections, I obliterated a budget, I reworked an algorithm (and a budget), I spent the budget, and I transferred my knowledge to the current and future coordinators. Overall, I had a pretty awesome experience.

There are special thanks and acknowledgements which should go to the CDC Foundation and the Hubert Family for providing me funding to travel and work on this project. Thank you to CDC / KEMRI in Kisumu, Kenya for allowing me access to their plentiful resources. Thank you to Deron and Godfrey for their mentorship, as well as George, Peter, Allan, Ratwar, Janet, Rachel, Kenneth, Fred, Rhoda and so many others who helped me succeed.

Mama Sarah's

Rat leading the way

A week ago I mentioned to Rat that I was considering visiting Mama Sarah. I told him, I had been worried about just knocking on her door to say hello, but I had decided (with a single weekend left) that it would be a shame if I made it all the way out to her region without greeting her. After all, in this tradition, the greeting is everything. I also figured, I definitely wasn’t going to be the most annoying person to visit her compound (think Fox News and any media outlet owned by Rupert Murdoch, or really any media).  And I was going to bring a gift.

But what gift do you bring to Mama Sarah Obama? After a few months here, there’s really only one appropriate gift and that is an animal. The Luo people prize their livestock and so I figured I would see what I could do. I told Rat I wanted to bring a goat. And he laughed! And laughed! And recommended I bring something a little more practical, like fabric or something American. The conversation was lost and I figured that my trip to see Mama Sarah was over before it started.

I got a call from Rat on Tuesday and he said he had been thinking about our conversation and that I was right, a goat would be a great gift. (He later told me that while it was a great gift, it was an even better story for him to tell, that he went to visit Mama Sarah with an mzungu from America who brought her a goat). He had already talked to his friend in Kogero about where to find a goat. We were in business. Sunday was go day. Throughout the week I would get phone calls: I’m getting a goat, I can’t get a goat, the goat is too small, how much are you willing to pay for a goat, do you want a boy goat or a girl goat, we’re getting a big goat, and so forth.

Our goat

On Saturday afternoon we planned the trip, we were meeting in town at 5:30AM and on a bus at 6AM to Kogero—we’d get there at 8AM and take motorcycles to Mama Sarah’s compound. Hopefully we will meet our goat when we get to the compound and the price will be no more than 2000KES ($25). Oh yeah, bring a back-up gift.

The transportation plan goes without a hitch, we arrive before the town has awoken. We take chai and eat it with stale bread because they haven’t even started to make the breakfast breads yet and hop on motorbikes to Mama Obama’s place. We are driven up to the gate—it has been fenced in, otherwise I think the guys would have driven us to her bedroom door. We get off, and no goat. Not to worry, we are not all that timely here. I look at the sign on her fence, and it has visiting hours for M-F and Saturday (Sunday is not mentioned). Now me, I thought that meant that we were sunk, but Rat just walked up to the gate and greets the guy in Luo—he’s not Luo so they switch to Swahili and I follow along.

The conversation was long and not interesting, I thought about writing it out, but stopped. The gist was simple. Where is this mzungu from? (America.) Where are you from? (I just greeted you in Luo.) What do you want to do here? (Greet Mama Sarah and bring her a goat.) We did not have the goat at this moment, but we had faith that a goat was obtainable somewhere in this great little village and we had connections. I think the goat swung the conversation and the guard said, Mama Sarah is not up yet, but once the sun comes up and it warms up a little bit you will be welcomed on to the grounds. Oh yeah.

We walk into town and meet up with our goat connection—he works for the CDC which is an amazing network to be a part of. And he has to hop on a motorbike to get the goat. I give him the 2000KES and he gets going. Rat being a good man and accustomed to the ways of the mzungu and the mkenya had negotiated 1600 for the goat but figured he didn’t want to disappoint me by having the price increase and that the negotiated price might increase on the day of the sale. As it turns out, this wasn’t quite the case, but apparently, the goat we had bargained for was owned by the wife and she did not want to sell the goat. So our wonderful friend Vincent, went HOUSE TO HOUSE in search of a goat. As Rat said, “Someone who sells a coffin doesn’t bargain.” And if you’re going door to door and asking if someone has a goat, then you pay a desperation premium (200KES) and you get a smaller goat (the meat’s more tender).

So two hours of waiting, drinking tea, and just sitting, our goat arrives on motorbike. We meet the goat at Mama Sarah’s and we ask the guard if now is a good time to visit and he says yes. We enter, sign the security log and make a short walk up through her compound. It is very nicely taken care of and has a few animals grazing on the ground—no goats, but a few sheep which look like particularly close cousins to goats in this country.

We get to just outside the front door, under a few mango trees, and there are a number of chairs set-up. This is Mama Sarah’s receiving area and we are told she will join us briefly. We sit and are brought another book to sign, this one Mama Sarah’s reception book. It was started in October and is nearly full 6mo later. The goat gets tied up to a nearby tree and we sit and talk and look around.

After about 10 minutes, Mama Sarah comes out. She was dressed in a very graceful but traditional blue print dress with ornate gold embroidery around the collar. She comes to us and we stand to greet her and shake hands. I shake her hand last and greet her in Luo. She looks at me and asks if I have learned even Luo and Rat responds for me, since I’ve run out of Luo already, that we can speak Swahili together. She says that’s wonderful and greets us some more.

Rat, Mama Sarah and me

The vast majority of our (their) conversation was in Luo and I got very short translations for very long parts of conversation. When we spoke, I told her how happy I was to greet her and to get a chance to thank her for the support she had given our President. I was proud to have gotten the opportunity to vote for President Obama and I looked forward to the opportunity to do so again in the future. I thought he had done good and difficult work.

She expressed similar appreciation for my visit and said thank you for the gift. She agreed with me about the work President Obama has done, but commented that the wars were a concern for her. She was most grateful for the gift we had brought and she planned on having him for a meal soon.

In Luo, she discussed her life’s work with orphans—she helps them seek out education and employment. She said she was very thankful for support she had gotten from people from all parts of the world. We took pictures together, we said thank you again, I gave her my “back-up gift” (3 meters of a stately red and gold batik) and we were off.

Awesome day and a wonderful experience thanks to Rat, Vincent and Mama Sarah.

More pics: https://picasaweb.google.com/MatthewJMeyer/MamaSarahS?authkey=Gv1sRgCInE6aaOlonn_gE

A few pics and an article--

Some more pictures from Hell's Gate NP.

https://picasaweb.google.com/MatthewJMeyer/HellSGateNP?authkey=Gv1sRgCKj94L6Un6_kRg

And I liked this article, it's a little too much ("Here in Atlanta I carry around McDonald’s gift cards for encounters with homeless men and women, build Habitat for Humanity houses and donate 3 to 5 percent of our family’s annual income to charity."), but the sentiment is right on.

http://travel.nytimes.com/2011/03/13/travel/13prac.html?ref=travel

Housekeeping

Firstly, I will be trying to become a surgeon somewhere as of the end of June. I officially have matched. I find out where on Thursday around 7PM here. Go to http://med.uvm.edu/ and follow the links to the Match Day Live Webcast (or something like this). Depending on the internet, you may find out before I do!

Now. I called my sister on the phone last weekend. I hadn't heard from her in awhile and she hasn't (up to this point) taken the opportunity to call me, so I thought, I'll make sure she's ok. I got her on the phone and one of the first things she tells me is..."I stopped reading your blog."

Thanks.

She said it was mostly because she didn't get a shout-out. I didn't realize this at the time, but for my tens of readers, if  I did not include you in the shout-out section of the blog, it is not because I don't love you or appreciate the fact you're interested in keeping up with me and what I'm doing. Not at all. It's likely because I don't even know you're reading. So let me know, I don't want to lose more readers because of this misunderstanding. I actually thought I was over-estimating my readership by shouting-out to a dozen people, but I guess there may be a handful more.

And for those of you who didn't get a shout-out and are STILL reading, thank you for not being as much of a grump-face as my own sister.

Work Update 3

The big news is our / my / the project got final approval from our group of TB specialists and consultants the world over.  This includes a pretty significant deviation from the initial plan when I arrived, and I think that if I’m to point to one real effect I had on the project it would be this. I identified some inefficiencies and fallacies in the beliefs underlying the original algorithm and I helped to streamline a new algorithm. I think the data will be cleaner and the people who will actually implement this project will be much happier.

I just tried to explain a little bit of what I did, and it gets really boring, really fast so I’m all about telling the story, but send me an email or call me up and I’ll give details. Preliminary results will be available in a few months and then real results in a few years.

I’ve got less than two weeks to go here in Kenya, how quickly time passed. And at this juncture, especially considering that we just got the project officially off the ground, I need to figure out what work I should keep doing, and what work I should tidy-up and leave for the Hubert Fellow who is following me. Rishi if you’re reading this, this is you J Right now, I’ve decided its best for me to write this down, and this.

Time to get back to work.

Lake Naivasha and Hell’s Gate NP: Trip 4 out of Kisumu

I thought Lake Naivasha was half-way between Kisumu and Nairobi—like a three hour bus ride. It’s sort of a suburb of Nairobi and takes 6-7 hours to get to from Kisumu by big fancy bus. By crappy matatu it takes 6-7 hours but it feels so much longer as every three minutes you see your life flash before your eyes.

Lake Naivasha is the ancestral home of the Masai tribe—one of the few tribes in East Africa which has attempted to hold on to its culture in the face of globalization and nation building. Sadly, they lost most of the ground around Lake Naivasha to flower plantations. Lonely P told me that a flower could be harvested in Lake Naivasha in the morning and in your European lovely’s bouquet in the evening. Pretty impressive and gives you a thought for the scope of these operations. There are literally hundreds of very large greenhouses surrounding this fresh water lake in the heart of Kenya. And scattered in-between all these giant farms / communities are little campgrounds.

Entrance to Hell's Gate NP

I went with Steph (another Hubert Fellow) and Aaron, and we chose from the LP to stay at Connelley’s Camp. Expecting Irish, after some ridiculous back and forth with the moto-taxi drivers, we realize the camp is actually called Carnelley’s Camp and costs twice as much as LP claimed. Still, it is a stunning campsite with hippos in the lake—right there.  Actually, the hippos could be a little too close at times and at night, the lovely Carnelley family places an electric fence to dissuade the hippos from entering the camp grounds and eating the campers. I never got around to touching the fence, but I was curious as to how powerful an electric shock needed to be to stop a hippo.

The next morning, wake-up early and head for breakfast (four maandazi—fried dough, and three cups of tea, shared among three people—what the hell were we thinking for a full day of bike safari?). As we sit enjoying our meal, the gentleman who is serving us (and we’ve gotten to know pretty well from multiple meals) goes and finds an entrepreneurial soul who is willing to rent us mountain bikes for 500KES, 400KES, 300KES per bike—it was impressive how quickly the price went down and I credit this with the incredulous look on my face because LP had said the cost should be 50KES at the park to rent a bike—I think someone never quite made it to Lake Naivasha and chose to phone in this chapter. The correct price is actually 500KES at the gate to the national park, so we got a deal except for the fact most of our brakes worked marginally (“it’s very flat in the park”—except for the giant mountain if you go left) and the seats sucked.

Quality of bike aside, you enter the park and are greeted by rugged, dry, beauty. It was simply stunning. You bike for a bit and there are some gazelle, a little further and a warthog family, to the left a giraffe and to the right a zebra and damn, I almost hit an ostrich. A few times during the day we pulled off the road, stashed the bikes and walked into the park and the fields of giraffe and zebra. The only animal that could be a little dangerous was the warthog, and we gave full clearance to him and his kind but all the others are relatively passive and somewhat skittish. That was the day, biking and walking safari.

Shout-outs

Erin -- I spent the better part of two nights trying to record the sound of the lion from my window. All I ever got was a very weak sound which if I posted would not be impressive and would make you think I was lying about the lion. I wasn't but I have no proof. I did try.

Eric / Tom / Nick -- I have a new appreciation for all the work you do on Excel. One of these days you are going to get a phone call from me at some un-Godly hour and I will be asking you how to use the logic functions of Excel. I know that Excel possess functions that would probably make me cry for how simply it would replace hours of my time manually manipulating data.

Nick -- I already sent you the email, but...ONE MONTH til Serengeti / Zanzibar -- can't wait to show you around

Marisa / Tony / Michelle / Jen -- Can't wait to have our reunion in the Deep South, just a little more than a month away. Hard to believe its been four years.

John William -- I think I have written more blog entries in my one month aboard than you in your 8 months...I like reading what you're up to, keep 'em coming, that last one was especially good.
http://vermont2peru.blogspot.com/

Mom -- Hi. I know you will be the first person to check on this blog, so I'll pass that along.

Jessica -- You get the one and a half month warning, you're gonna travel like a local and see all my favorite places and people. It will be a true experience and it will be great to share it with you.

Everyone -- I currently have readers in six countries and I am hoping to improve upon this, so if you can get me a new country, it'll make me happy. And I really think that's only five countries since the Kenya hits are probably just me.

Work Update

I spend a lot of time on the computer. You may have noticed this, considering my frequent blog updates or faster than US email replies. But most of the time I am not messing around, but actually working. I am going to be at time vague in my description of the work, unlike my other blogs where I tell you the color of bananas I ate or exact greeting my host used, because some of this information is not mine to share. That said, I hope it's still sort of interesting.

My first week was field work, understanding the work flow of the system I was going to be modifying.

My next week was projecting numbers for the algorithm / case definition for TB which has been developed by experts throughout the world.

My next week was convincing myself that the numbers I was projecting were real, and much bigger than expectations.

My next week was coming up with my PI and colleagues, novel ways to address the issues I had uncovered and do our work as best as we possibly can, inside of the limits set by finances, culture and reality.

Remember the 25,000 kind souls who answer questions weekly about their health status? Well, our plan was to add a few more questions to the survey and see what the prevalence and incidence of TB in the community. Furthermore, we wanted to trial an "intervention" of TB screening done through a combination of clinical diagnosis, CXR and a fancy new polymerase chain reaction (PCR) machine which would then function as a point of care test (POCT) for the clinic. It is a nice idea, however, logistically very challenging. My work is to figure out how to plan for all this to take place, and ideally, be around to set the stage for the kick-off to take place.

The actual day to day of my work involves a lot of excel. If this sounds familiar to my medical school readers, it feels familiar to me. Instead of sitting in my seat in the library where I am hoping to get a plaque, I am sitting on the second floor of a sweltering office complex in East Africa, sweating (a lot) and putting in numbers and formulas instead of medical facts and disgusting pictures.

Those 25,000 people, have generated a lot of data, and what I am doing is taking the data which seems appropriate from their answers and extrapolating it to the algorithms for our diagnostic chart. And trying to think through all of the steps along the way. Some of the data is readily available from years past--HIV prevalence rate in the community; cough / fever complaints; population demographics. Some of the data is based on expert estimate: how many people will refuse an HIV test, how many people will have a CXR which will rule in for TB and require further testing. And then some of it is based on pure guess: how many people will be willing to walk to a mobile field site for a sample?

So I take all this data: real, estimates and guesses and put it together into an excel spreadsheet. Actually, many spreadsheets, although I am working on making it into one big spreadsheet with a bunch of different workbooks. Is my terminology correct here? I don't know.

And once I have those projections for our community, I have to estimate on a budget. This is interesting, because I always wondered approximately how much people make in places like this, and now I know. I have to try to accommodate for everyone and everything which may cost a penny. My working philosophy is that whatever I can run the budget up to on Excel, I should add between 10-20% because that gives me cushion. I haven't done that, but that's in my head. And this research ain't cheap.

I did this all for my community, Lwak. And the reason I have down time right now, is I am waiting for data from the other site in Nairobi to give it the same treatment. Presuming all of my formulas are right, which is definitely a presumption, but I think a correct one, it is all clerical at this point and things should just fill themselves in. We'll see.

"The sun sets at 6:20": Trip 3 out of Kisumu

David moved into the place where I was staying at, the Pabari's Paradise out-house; he is a candidate for a PhD in soil science from Cornell. A very nice guy and slowly becoming a very respectable Kisumu local, considering he spent extended periods of time in Kisumu often throughout the past few years. He also has wheels, and he invited me, along with another of his friends from Cornell, to visit the village where the families of several of his friends live. I took him up on this generous offer and we had two great visits.

It took about 90 minutes to get to Mumias, a town built around the production of sugar and the agribusiness Mumias Sugar Company. Travelling in a car is nicer than travelling in a matatu--its also much quicker, and depending upon your driver, you do not feel as though you are going to die--David was a very good driver.

We then stopped for tea because David's friend who was going to guide us down the maze of back roads to their home, was still on his way to find us. I remembered that more than two chapati (especially if it hasn't been freshly cooked and has just been absorbing the grease from its neighboring chapati) is more than enough chapati for anyone.

Once we were all together, we stopped by the market to pick up two chickens as gifts and some other insundry kitchen supplies to deliver to the family we would be visiting.

Entrance to the family compound

We got to the first compound in the middle of the sugar fields and were greeted by the entire extended family dressed in their finest clothes. We were welcomed into the head of the compound (Mzee)'s hut first for introductions and to deliver our gifts. We were then shuttled to the hut of the eldest son who is still living on the compound for our meal.

Mzee's house

EVERYTHING--I can't stress that enough--EVERYTHING that we ate was harvested from the immediate farm and a result of the hardwork of the people who shared it with us. The meal started with a few bowls of peanuts and seasame seeds laid out on the table in front of us with milk tea (the tea leaves were probably not from the farm, but they could have been). And after filling up on these snacks, the meal was brought out--plantains, arrowroot potatoes, sweet potatoes and cassava--more than I could ever eat. And after I had eaten as much as I could, and there was plenty more left, they brought out sweet bananas for desert. It was a beautiful spread of food and the company was great.

Most of the younger generation spoke some English, but the Mzee and some of the women did not speak English but could understand Swahili so I was able to communicate with everyone, which was particularly special. It was also pretty funny, how after me speaking with the Mzee for a little while, one of the older sons began to translate our conversation into English for David and his friend.

We finished eating, heard a small bit of history on the lands from the Mzee and walked around to see the grounds. It is just (inshallah) the start of the rainy season so there wasn't too much growing but it was still special to see where they lived and where our meal had come from.

Mzee and his family

As we packed up to leave and say our goodbyes, we were handed some gifts including a huge bag of roasted seasame seeds and peanuts, as well as two chickens--different from the ones we gave, but of the same type. We jumped into the car, and off we went to travel to the next (and last) compound.

When we arrived at this compound we were greeted by the elder mother and spent time in her house. We gave her the chickens we had received (Pabari's Paradise frowns on raising chickens--as well as many other things) and entered her house for introductions. Here we learned that our hostess was one of two wives for the late Mzee of the household. She had twelve children (only 3 sons) and the Mzee had taken another wife in hopes of getting more sons (she had three children, two sons). Fortunately for our stomachs, this visit was the reverse of the last visit and her sons grabbed us and showed us around the property first and then we sat and talked, and then we ate--again the food was copious.

One special meal we got was "Aliya" which is a special Lou food of slow roasted / dehydrated beef. It was delicious and its a genuine treat as beef is expensive and the labor is great to cook it. We had fresh fruit, multiple types of ugali, chicken, local greens and much more. Another beautiful meal to remember.

As 6:20 was approaching and the sun was setting, we said our goodbyes, piled into the car and gifts of peanuts in hand, we left happy and having had a true day to remember.

Mbita Island: Trip 2 out from Kisumu

Approaching to greet

Mbita was great. The drive to the ferry was wonderful, until the last few kilometers which were terrifying. The matatu was late (as we had been sitting in the bus stand for well over two hours) and it needs to meet the ferry at the dock in order for us to get on the ferry, and them to pick-up ferry passengers and take them to Kisumu. The entire trip, the conductor had been hurrying people on and off the matatu (“fanya fasta fasta”) was what he kept saying to the passengers as the driver took off before both feet of the new passenger had left terra firma. And by the time we were just outside of the ferry, the driver was being motivated by other matatu conductors who were coming back from the ferry who were gesticulating that the ferry was leaving. Each matatu we passed made the driver accelerate harder and check his speed less. And there we were barreling at who-knows the speed (because the speedometer is either broken or disconnected) towards the lake, downhill and around curves without ever really breaking. We made it—on the ferry and to the island.

I arrive at the island and everyone wants to know if I want a taxi—no I don’t because I don’t really know where I would go. So I walk. And I just walk around and people greet me friendly and little children run to me and say hello. People ask me to take their picture—and I oblige and have some cute pics of little kids. I just walked and talked and took in the environment. It was really hot, very dry and dusty and quite beautiful.



Piga picha

I ate lunch at a small shack on the “causeway,” which links together Mbita and Rusinga islands. I got a big old fried fish with ugali and cabbage and sat and ate for about an hour listening to the guys next to me babble back and forth in a mixture of English, Swahili and a tribal language I don’t know. I paid and I left and slowly walked back checking out the stalls along the way.



Sandals made from old tire



The entire time I was on the island I was greeted so warmly and I was never asked for anything, at all. Except for one situation—I passed a group of young men sitting under an open air shelter and they approached me with a notebook and asked for a contribution (mchango). This is a really common thing to do for sports teams, schools or other community efforts—everyone around donates what they can and maybe something happens.

The boy, the youngest of the group, approaches me and asks me to contribute and shows me the book. This is an old school book with a list of names ~100 long who have donated anywhere from 10 to 200 KES (0.10 - $2.50). But there’s a picture on the front of this notebook, and the boy says that it was his brother and that he passed recently. This is another common tradition is for the community to contribute to the expenses of the funeral as well as the well-being and future of the family. So I looked at the guys one more time, always in the back of my mind wondering if I am about to be taken, but I went on my gut and I had been so well received and so comfortable in my visit that I pulled out 50 KES and gave it to them. I always look at the contributions and at the one that appears most often and go a denomination or so above.

As I pull out the money, and sign my name in the book, I see the guys behind my young friend smiling and welcoming me to the town and Kenya, thanking me for the gift and wishing me good luck with my journey.

Picasa Update--

https://picasaweb.google.com/MatthewJMeyer/KakamegaForest?authkey=Gv1sRgCLW647rOqs65wAE#

https://picasaweb.google.com/MatthewJMeyer/MbitaIsland?authkey=Gv1sRgCLug_ribyrLRqgE#

https://picasaweb.google.com/MatthewJMeyer/AroundMumias?authkey=Gv1sRgCMC829nPtYOEGg

Three albums worth of photos--not too many, but you need to link through these to get there.

Bus Standi

Main bus stand in Kisumu

I got Friday off from work. The bosses were gone to a "retreat," whatever that means, and I had finished my work for the week, and maybe longer (interesting story, call for details). So I decided to see what the world had to offer me around Kisumu. Since I don't have access to a car myself, this meant a "matatu" ride. For those of my readers who are related to me, which is many, a matatu is a little, little gentler version of a "daladala." And the only reason they are a little better is they seem to be newer, I think they send the broken down matatus to Tanzania and breathe life into them and then call them daladalas. I really do.

I got to the stand early, because if you're going to travel anywhere by an over-stuffed mini-van you want to start early because these things move slow. I got there at 7AM which is earlier than I arrive for my transport to work--I was motivated, amped and ready to go. And you know where this goes, I was the only one. The Kisumu bus stand is timid as far as my experience in East Africa goes. I got there and had to find someone to ask where my bus was located--usually, I can't get within 100m of a bus stand without being offered transport to the far reaches of the planet. But here, I had to find someone, and basically rouse him from his stupor of collecting $0.50 from each bus that exited the stand. He pointed in a vague direction, which was really all that I wanted, and off I went.

I find the bus and the driver says, get in-- I look in, and its empty. Not a good sign if you want to leave soon, because it ain't leaving until its packed. So I look at him and say I'm off to get chai (breakfast) and he says, I'll join you. And then says I should leave my bag in the front seat to reserve my spot. I'm trusting, but seriously, I could just hand my stuff out to people because then I would at least get to choose who made off with my goods. I told him I would take it with me and get whatever seat was remaining. Honestly, the front seat is the choice seat, as long as the person between you and the driver (you didn't think we wouldn't use the "seat" where the stick shift was) isn't fat. The other issue with the front seat is you can actually see what is on the road and the ridiculous / dangerous driving choices your driver has opted for--passing on a curve, passing on a hill, passing on a hill and a curve, passing into oncoming traffic, nearly hitting a person / motorcycle / goat, driving too fast, pulling off to pick up a passenger when there is no shoulder, etc.

Chai came and went, and back to the matatu. My seat still remaining, along with most of the other ones, I hopped in and sat, for two more hours. Fortunately the bus stand is pure entertainment. I would say 90% of the people (and this is probably a dramatic underestimation) at the stand have no intention of getting on a bus, maybe ever. They make their living at the bus stand (making a living may also be a bit of a stretch, but it's their source of money). This includes all sorts of employment or mischief: bus drivers, conductors (guys who cram themselves into the matatus and collect the fare from you, and cram more people on the matatu), police officers, transportation officials, people hawking ALL sorts of goods (including, but certainly not limited to, bananas, CDs, DVDs, socks, pad locks, sunglasses, hanker-chiefs, wallets, underwear, water, biscuits, gum, candy, hot-dogs without the bun, buns without hot-dogs, newspapers, phone cards, toys, chains, rope, and soda), pick-pockets, prostitutes, drunks, beggars, people selling meals, people selling produce and dry goods, bicycle-taxi drivers, regular taxi drivers and touts.

I want to focus on the touts, because they are my favorite. These people will do anything for any sum of money. You name, they'll do it. As soon as a bus pulls into the station the touts flock to it and usually there will be two or three on top of the roof (because that's where all the goods are stored that travel with the bus, obviously) starting to unload before the bus has parked. Usually these guys (and they're always guys) are between the ages of 15 - 30 and they just "hang-out" at the stand hoping to get a little change here and there for assisting.

Once the goods have been unloaded from the top of the bus, they usually are handed down to another tout on the ground who packs them on his cart--I don't have a picture of the cart but I hopefully will get one so you can see how impressive these things are sometimes. They are home-made at a welder's shop or constructed out of wood and they load these things like you absolutely wouldn't believe. And then they hop in front of the cart and just start dragging. Seriously, world's strongest man ain't got nothing on the huge amounts of weird things these people will pull places--and all for much less than a dollar.

Other touts work for the bus companies, and I think work is way to generous, I'm not even sure if they are associated with the buses in any fashion other than they try to bring people to buses and ask either the person to pay something for the help or the conductor to throw some shillings their way for helping them get a person to ride. And these people will try anything to get someone on board.

They'll shout at you, they'll block your way to the other bus, they'll grab your hand, they'll promise you the world just to get you on the bus they want you to be riding. I even saw a young tout trying to talk the conductor of another matatu to get on our matatu. Now this would be like if an apprentice for a store clerk at Hudson News in JFK Airport tried to talk the co-pilot, flying the Delta shuttle to Detroit, into paying for a flight on United to Durham.

After getting so bored that I actually purchased some CDs through the window, I took off for Mbita.

Kakamega Forest: Trip 1 out from Kisumu

Last weekend I went to Kakamega Forest with Aaron, my new friend who is a relatively new EIS (Epidemiological Intelligence Service) officer. It was really just an excuse to get away from Kisumu for the weekend. I don't think there are too many people who travel too far to visit Kakamega Forest, but I'm glad we did.

It was a very low-key weekend which involved renting space in a KEEP (Kakamega Environmental Education Program) banda--of note, the KEEP bandas looked exactly like Smurf Village--and eating all our meals at the local "canteen." The canteen looked like a run-down hunting cabin which housed the kitchen, a small store and a few benches and tables which was occupied by progressively fewer chickens throughout the day. The proprietor of this institution was a lovely woman with three children including a little guy who was about 1 and would respond to "Hello" with "Hello" and he would do this forever, Aaron must have said it 50x in a row and then he got bored but the kid didn't. At the end of each meal, we would order our next meal from a hand written menu. We never got what we ordered, but we weren't picky and the food was good, so...

We also took a guided hike in the morning. We were given the options of hiking to the river or to the hill. I asked what the difference was between the two hikes besides the 200KSH more for the river, and our guide, Elsie, said there were more open spaces on the hike to the river. The more open spaces meant more variety of plants and a better opportunity to see some of the over 50 plants with medicinal properties. We chose the hill.

Top of the hill

After she grumped at us for being late eating our breakfast--lets not mention that we were on time, our food was not, we headed out on our hike. She started out like a real tour guide, telling us all about the forest and the animals and the plants, and she turns to us and says, "Did you know there are over 50 plants with medicinal properties in this forest?" Why yes, we did, you just told us half an hour ago.

Aaron and our guide

Within minutes of stopping we have encountered a medicinal plant--it looks like a bush, shoulder high, with pipe-cleaners of fuzz attached to it. She gives us its latin name and says it numbs the throat and gives the mouth a fresh feeling for hours. She looks at us, and the entire time she is dressed in a safari outfit, with binoculars around her neck and sunglasses on that are crooked, looks at the plant, grabs a pipe-cleaner, chomps on it and continues down the trail. I think to myself, how messed-up is she going to be if she continues to sample all 50 of the medicinal plants in the next few hours? She didn't snack on or point out another plant for the rest of the hike, and she was actually quite pleasant and well informed.

Good Day

Today I went to a two year-old's birthday party. But this was no two year-old's birthday party, this was the son of my friend Rat who took me on the tour of the community in which my program does its surveys and gets its data. So I was very honored to be invited.

Rat lives on the outskirts of town in an area named Manyatta. I did not know where that was, so I hopped on a boda-boda baskeli (bicycle taxi) and told him where I was going. While he knew the general area of where I was going, he didn't exactly know but he didn't let on until he was asking people along the way--who also didn't really know where because where he dropped me off was not really where I wanted to be.

So as my driver took off to wherever he spends his time waiting, I gave a call to Rat and said "Nipo (I'm here)" and he said I'll be right there. As I stood looking around, I was welcomed into a little banda to sit in the shade with some guys and we chatted in the typical blend of swahili and english. They asked the usual question. Where are you from? What are you doing here? What's your name? How do you like it here? And one that I get quite often, do you like our Obama? I'd hate to be anti-Obama here because so many people take such pride in his success since he comes from their country, and for Kisumu, their tribe.

I get a call from Rat, "Where? I don't see you." That's not what I wanted to hear, because if he doesn't see me, I'm not where he is because I don't blend in. I asked my new friends, where I was and they said "Akambatu" which was not where I was supposed to be. Rat said I wasn't far and I told him I would walk myself there right away.

One of the guys says "Why not take a boda boda, its only 10 bob (shillings)." And another says, "Why don't you just take him, he's out guest." And the guy with the bike tells me to come along, and he pedals me a few minutes down the road so I can meet up with Rat.

The party, I learned was beginning at 2PM and I was there at noon, I hadn't quite planned on an all day event, but then I hadn't really planned on anything else so I was there for the long haul. He had invited me earlier to just talk--which I thought was really kind of him. I really enjoy hearing his ideas, and I think the best description of him would need to borrow from K'naan and be "dusty foot philosopher."

We spent a fair amount of time discussing the tree farm he is creating on a veritable piece of scorched earth inside the area where we run our study. He says it was dry, dusty and had a little brush on it, but he has decided to return it to a forest with indigenous trees. He goes out of his way to collect ornamental trees that are native to the area and hopes to preserve their existence on his property as an environmental effort with his own work and funds. We talked about the troubles he has trying to get the documents for the land and the importance of having the deed. We talked about how his neighbors didn't understand what he was doing when he started a little over a year ago, and how they're starting to see the results already and asking him about how they can emulate his work. We talked about how his friends ask him why he isn't trying to make a quick profit by selling firewood or growing fruit trees. We talked about how he will handle people looking to cut down his trees for firewood. He knows he may not reap all the benefits of his land but he looks at his son and says, "Maybe he will benefit or his kids" and goes on to explain that its a gift he wants to leave for the future generations through his sacrifice.

The party was great--plenty of soda and absolutely delicious foods. Chipsi cassava and sweet potatoes for snacks. And a beautiful dinner that had so much more food than was necessary--chicken and fish and meat, ugali, rice and chapati, and of course a cake. I also got to meet a few people at the party from work both foreigners and Kenyans. We covered great conversations about politics, work, life

It was wonderful to get out of the wazungu area and get to where the real Kenyans live to experience the Africa I had been missing.

Thoughts--

It is 90 degrees different between where most of the people are who are reading this blog, and me. Hah!

The vibrate / silent mode for cell phones is under utilised in Kenya. My favorite is someone's phone behind me says "Sorry Boss, but you have a text message" every time a text is received. A close second goes to someone on the other side of the office whose phone rings "O Little Town of Bethlehem" with each call. And the most popular person in the office (who doesn't have their phone on silent / vibrate) has the Travie McCoy (his first name is Travie) song "Billionaire" that I hear at least twenty times a day.

And is there anyway this is true? http://kenya.craigslist.org/for/2211420435.html
Or this? http://kenya.craigslist.org/zip/2150902833.html

Six and seven and eight and BUNCH

My desk--you can see the bananas on the left

I left the CDC campus today for lunch. I ventured outside of the gate in search of food. After one week, I am already tired of the menu options inside the compound. Actually, I think they just don’t use enough oil and salt when they cook, and truly, when you’re eating beans and rice, those are two ingredients that are needed in excess.

Immediately outside of the gate there are a few stands set up by entrepreneurs who sell breakfast, lunch, soda, phone cards, fruit and other incidentals. These people are collectively referred to as “Jua Kali” which means “fierce sun” and is slang for informal employment. I had been eyeing one of the stands on my way into work in the CDC special transport morning van for non-Kenyans, temporarily working in Kisumu and living on the right side of town. I am actually surprised it took me this long to eat there.

CDC van at the compound

My restaurant, or “guesti,” is called “Researchers Favorite Café.” How could I go wrong? And I didn’t. The best beans and rice I have had since coming to Kenya and for $0.50 we’re talking my price range too. But I was still hungry. Thankfully, there is always someone around who is able to help you out with what you need, when you need it. And there was a mama sitting in the shade, right by the CDC gate, selling bananas and some type of root. I chose banana.

But I only had a 50KSH ($0.65) bill and she, of course, had no change. “Why not buy 50 shillings worth?” she asked me. Now, sometimes this is a little of a trick, and sometimes the person doesn’t really have the change. I asked her how many bananas I would get for my 50KSH and she pointed to a whole bunch of bananas, like 10. Now, what’s going through my head is I paid 20KSH per banana last week and was expecting to get maybe three bananas for my money—I got screwed. So I bought 50KSH of bananas from her, ate one and handed them out to people I knew as I walked back to my office—I still have some to bring home.

Two roads diverged in a wood, and I--

I went skiing the weekend before I left for Kenya (actually off the slopes 18 hours before my flight departed). I thought it would be a good idea, and it was a great one: fantastic company, and two good days of skiing. Only problem was my second day did not end well. I was trucking down Timbuktu at Jay and went past the usual turn-off in search of fresh power—no problem, I’ll just take one of those trails that helps you cut back. Problem is, that area always looks different to me no matter how many times I ski it and I never know where I am, I just have a feeling for it and know when I need to cut to the left to avoid ending up either on Rt. 242 or hiking out.

This time I turned back a little early and didn’t hit either of the traditional returns. I thought I had gone too far and got worried. I have hiked out and it sucks. And I have waited for someone to hike out, and that sucks and I didn’t want to put anyone through that. So I figured, keep your speed and head towards the left. I did exactly that and the tracks that I was following went between two trees about four feet apart, and a little staggered—no problem, except I hit one, with my leading knee and it hurt. Long story short, I recovered (thanks Dr. Geer) but am still a little hobbly over here, and the walking portion of my morning commute sorta sucks.

The walk I had been taking is on a quasi-main road with very uneven paths on either side and I was occasionally walking in a ditch to avoid the “boda-bodas” (motorbike taxis) and “dala-dalas” (over-stuffed, under-repaired minivans). This terrain was not good for my knee as every step that I laid was uneven. Now I am doing fine (that’s for my mom), but it was just irritating and obnoxious to take this path (~20min) both in the morning and afternoon. I had begun dreading my walk in the morning, dodging traffic and tenderly protecting my knee and I had actually taken to grabbing a “bicycle boda-boda” to get to my van in the morning. Now I don’t have any complex about my fitness or health, but there is nothing like a young man riding out of his saddle and struggling to pedal his bike simply because you hopped on, to remind you of your weight. They definitely earn their 20 shillings for the 2K.

The new path

But today, I took a different path. And that path was by the Kisumu Impala Sanctuary. Now this isn’t the Serengetti. It’s closer to a zoo than anything sublime, but I did get to see impala this morning, as well as a pacing lioness. Again, the lioness was pacing probably because she is caged in a large fenced in area and the impala are running around her in their own fenced in area. Still, this beats the hell out of any morning walk I’ve had in awhile, plus it gets me off the main road and that improves my own personal chances of survival.

The lion's area is in the fence behind the impala--and yes, I hear her roar every night when I am falling asleep

I think the best part was I wouldn’t have looked, except one of my neighbors was standing on a cement tank near the road and when I asked what he was doing; he signaled me over and shared the sight.

This may explain it all...

Kupotea njia ndiyo kujua njia -- To get lost is to learn the way

Field Work and Fact-Finding

The past two days I have been visiting the rural part of Kenya where my TB surveillance project will occur. I had the opportunity to follow a CI (community interviewer) to the compounds and households where the health interviews occur.

The gentleman who I accompanied is nicknamed Rat--which is short for the world elephant in Dho-Luo because he is a giant--not only in stature but also in warmth, personality and intelligence. He is now a TL (team leader) but was once a CI years ago in the village in which we were visiting. Everyone we passed greeted him and asked where he had been for such a long time. He passed on some sage words, "To succeed in this job you must have a huge heart and a small brain."

We visited 10 households and he patiently explained the system of interviews, and I am going to save you from the details but suffice it say, it's thorough and 25,000 people a week are run through this. Amazingly everyone I saw greeted the interviewers kindly, stopped their work and answered questions for 20-30 minutes.

Despite my living in Tanzania for two years, I entered as many mud huts yesterday as I had in all my time there. I did not take pictures of the inside (and I will get a picture up of the outside so you can appreciate where I am) but I will explain to you the best I can.

There is only one hut design in this area--you duck low to avoid the roof to enter the doorway set in the middle of the house. You enter immediately into a greeting area with chairs or couches with foam cushions aligned along the right side and the back with a table in the middle. There are a few pictures, a calendar or small decorations attached to the walls. The room is divided from the sleeping quarters by either a mud interior wall or a sheet. On the other side of the sheet is where the family sleeps--everyone. In the framing for the roof there are woven grass mats, farming tools and other possessions in storage. Small livestock are as present in the home as the family.

Upon entering the room you are immediately struck by how hot or how cool the structure feels and this is completely dependent upon the roofing. Grass roofs are very cool but need to be replaced twice yearly. Metal roofs make the hut a sauna but you can collect rain water from them and they need to be replaced every 5-10 years.

During the interviews which were conducted in Dho-Luo, a language which I am sure I will pick up some--got "ahonda" for cough and "deip" for diarrhea and a few greetings so far, I sat and watched the interactions. Interviewees would very rarely give a "yes" or "no" but would respond almost nonverbally with cues that were mutually understood by everyone but me. I also watched the kids who were in the house--more than a few times it was mentioned that I was the first white person ever to visit their house, or the first their children had seen outside of a car. One little girl asked her mother if I was a woman--I hope she was associating the color of my skin with gender and there wasn't anything else I was giving off, especially considering I have a pretty solid beard right now and I consider myself masculine. At the end of the interview I would squat next to the kids and give them a high-five or let them touch my skin--a lot of them like running their hands through the hair on my forearm.

The next day I visited the hospital where our study will be centered and met with some more people. I also had a chance to have a little clinical experience as I learned about the work-flow of the office. The head clinical officer and head of the hospital asked me what a normal patient load was for a physician in the US. I said a busy family doctor might run a few rooms at a time and see 30-40 patients on a long day. He saw at least that many in the morning session, including five members of the same family.

Almost amazing I haven't mentioned much about the food I ate, but lunch for the past two days has been at a little guest house a few hundred meters from Lake Victoria where everyone comes to eat. It has been recommended to me by two of my co-workers out in Lwak Hospital doing field work for the IEIP. And guess what, when Senator Obama came to visit before launching his first campaign, he ate at this little guesti as well. The food's quite good and the company is even better.

Work

I am in Kisumu, Kenya and I am staying in a furnished house associated with a big guest house nearby. I can sort of see Lake Victoria out of one of the windows in the house, and I am told that I will be having two house mates at some time.

My condo development--looks like Florida

I got three hours of day light to establish myself in town, before I was told I was late for work. Seriously. Expecting a full day of figuring out where town is located, getting there and picking up some food and goods--since my furnished apartment only has a single towel which triples for pot holder, shower towel, kitchen towel and mop. I was surprised when a worker from the guest house came and told me that he had received a call from the CDC (Centers for Disease Control and Prevention) / KEMRI (Kenya Medical Research Institute) and they had been expecting me this morning. Funny, because while they have been great so far, I had no idea how I was supposed to get there, when I was supposed to be there or where it was located. This was kindly settled and my boss, himself, came to pick me up.


Plans always change. Always. I had made very few plans in my head as to what my experience would be like in Kisumu and working with the CDC. I knew I would be doing tuberculosis (TB) surveillance (didn't exactly know what surveillance was all about until the CDC Hubert Fellows orientation in Atlanta, so thank you for that) and I figured my office would be small since it is outside of the capital. Plans change. I will most definitely be involved in TB surveillance, in fact, I will be taking over the position of TB Coordinator for a woman on maternity leave for a project which goes live at the beginning of March. Moreover, the office where I am working is not small, but a huge campus which employs nearly 2000 people and has many, many more employed in the community.


There are some amazing things going on here which I would not believe exist, except I have seen them. This outpost of the CDC is in charge of the monitoring the health of nearly a quarter million people--this is called the DSS (demographic surveillance system). Every four months, each household gets a knock on the door and answers very basic questions regarding births, deaths, pregnancies and people moving in or out of the area. Impressive.


I am involved with the IEIP (international emerging infections program) which takes a small subset of the population (10%) in the immediate vicinity around our main hospital and visits them weekly, asking them an entire survey full of questions, about everyone in the house, babies, grandmas, renters--everyone. And then if one is sick, he is briefly examined and referred to the local hospital or clinic (which CDC / KEMRI run). And when he goes to the hospital, their every everything is documented and tracked. Health care is free if the illness pertains to the study.

Conference center where we have our field trainings for the "Community Advisory Board," 

"Village Reports" and others associated with our surveillance and outreach

And now TB health care will be free in the area--although it is already dramatically subsidized nationally by The Global Fund. IEIP is overlaying research regarding TB onto the questionnaire that exists, beginning in two months from March 2011. Beginning in March, we will be knocking on every door (~6000 doors / gates / curtains) looking for anyone over the age of 5 (~22000 people) with a symptom which could indicate TB--meaning if someone has a cough, fever, unexplained weight loss, or experiencing frequent night sweats, they will be presumptively diagnosed with TB. If a person answers "yes" to cough, fever, weight loss or night sweats, then they get a chest x-ray (CXR).


Its March in equatorial Africa: it's hot, it's dusty, the harvest season is months away and I sweat during the night--my bet is everyone is getting a CXR.


I, alongside of people far better versed in this world, will be coordinating these efforts in the coming months, and I am going to have some good stories...