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...