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.