Return from the first foray in the field

Yesterday, as I stepped into my room at the Fairview Hotel here in Nairobi, I felt a bit like I was walking into heaven. It also felt surreal after having been out in the field to now enjoy the standard of living and creature comforts that are a part of my usual life. Still, it’s so good to finally get a decent shower and feel clean and rested.

In the modern comfort of this wonderful hotel, I begin to reflect on my first foray out into the field here. Now, I can laugh at some of my experiences, smile about some good memories and small achievements, and ponder what I’ve learned about myself, working with the people here, and the critical issues around the work I’ve been assigned and how I might do even better to help here. Rather than go on in narrative, I’ll just let you see some of what I saw.

Typical traffic.

Visiting with the nurses in one clinic to assess their activities and supplies during the polio immunization campaign.

Some curious children.

In addition to assessing the progress of the campaign, I had the opportunity to help in many ways, including vaccinating some of the children.

Maui has nothing on the red dirt on the roads here.

Part of my responsibilities required visiting some of the homes in the extremely remote and rural areas to assess the progress of the polio immunization campaign in those areas.

Some typical Kenyan "rivers" - well, it is the dry season. Supposedly, if you dig under the sand, you can find water in some of these "riverbeds", although you may have to dig pretty deep in some places.

Once while walking through the bush in search of homes in a homestead area, we came out in the middle of a tea field. Pretty cool.

Marking the left 5th finger of a child to indicate we've vaccinated him.

One of the enduring images I know I will have of Kenya will be the many school children walking along the roads. They were always excited to see us and wave hello as we passed.

And a bit more on adapting

OK, I know I have it better than some of my colleagues in the field, but I have the need to vent about the hotel in Mwingi - just so if anyone ever ends up there, they're forewarned. My driver said that because it has no other competition, they may not necessarily be as motivated to improve things.

The 2nd time I had to stay at the Mwingi Cottage Hotel, I had to take a smaller room (that was fine) that lacked an A/C – very bad thing, although I didn't know it then. Why? Although the “A/C” in those units that have one doesn’t do too much to cool the room and is amazingly, offensively loud, it does provide air. Without it, the unit is like a closed oven despite trying to open windows – picture gasping, overheated, dried out, oppressed feeling when trying to sleep. I went through a whole liter of water during the night and was still dehydrated.

In addition, think bugs. Lots of them and all kinds and some in bed with you. Yeah. Not pleasant. I’m not sure why this time around this unit seemed so much worse than the one I’d been in during my previous stay, but I’ve never seen so many…and lots of ants to boot. Ugh. And yes, another cockroach sitting right by the shower drain when I returned from dinner. Nasty. Thank goodness for the bug spray.

Oh, that’s not all. The toilet didn’t seem to flush thoroughly…ever. And emitted an unpleasant smell. Wonderful. Not to mention the water that flushed into it was brown. Bad enough I was recovering from my bout with whatever GI malady; don’t want to think about if I’d been really sick while staying here. Blegh.

The shower? Ha. More like a trickle. And if I wanted hot water, I got it and only it when I hit the hot water heater switch. Taking a shower was comical. I’d hit the switch on and off and alternate between a hot and chilly trickle.

Regarding the meals, well, see my blog about Kenyan cuisine for a comment on one of my meals here.

I’ve never been so happy to leave a place and never felt such dread at the thought of ever having to go back there. There really are no other options in Mwingi, although I’m debating one. The only saving graces about the place were the friendly staff (they started warming up to me given that I’ve been around so much) and the land area for some decent morning runs. But I’m still ecstatic that I’m at the Meru County Hotel tonight rather than back in Mwingi. And soon, I’ll be at the Fairview in Nairobi.

Field work can be fun, but some aspects are not something one likes to have to endure long term.

A bit more on meals in Kenya

I think Lisa (my sister, who has trained at one of the culinary schools in NYC, is a foodie, and with whom I enjoyed a wonderful gastronomic tour of Barcelona) would be horrified by some of the food I’ve been eating. Some of it has been good. The hotel "chef" in Embu took good care of me. I had some pretty good curry sauce there, although I’ve never had such tough chicken. I really hate having to fight with my food, but that’s what seems to be the norm more often than not. A few times I’ve been pleasantly surprised by chicken that is actually tender, but most of the time, they seem to really overcook the chicken here or their chickens produce really tough meat or both. ?? And most seem to offer it only either boiled or “stewed.” [sigh]

Of course, most Kenyans would rather be eating beef and maybe goat, but thanks to Rift Valley, as I mentioned in an earlier blog, they’re being denied their usual cuisine. I only hope that I’ll get a chance to see and taste the true Kenyan cuisine, nyama choma, before I leave. In the meantime, I, like the Kenyans, am getting a bit tired of constant chicken. God forbid avian flu ever hits here though.

Margarine seems to be very popular, at least in rural areas, as opposed to butter. I’m not sure why they don’t serve butter, but only margarine seems to be served with your toast. And, I’m pretty sure that’s what they’re using to cook everything, especially the vegetables (like sauteed kale, cabbage, carrots, etc.), as it’s a pretty distinct flavor and the sauteed veggies taste pretty soaked in it.

French fries are also a popular starch staple other than the traditional ugali, and it's usually topped with ketchup that looks like it has a bit of a pinkish hue to it or some chili sauce. I usually opt for rice, which fortunately is another alternative available here.

I’ve been eating mostly at my hotel restaurants (not much option at night for a single female traveler in rural areas), and except the others, the one in Mwingi leaves a lot to be desired. When I traveled in Viet Nam, I tolerated finding a long hair in my noodles. In Mwingi, I’ve had to tolerate finding a hair as well as the other night, dead ants in the stewed chicken. Blegh. Oh well. Extra protein, I suppose.

I’m looking forward to some better eats in Nairobi.

More on maladies

Never ever ever think that bringing a mass armamentarium of medicines is overkill. I’ve never been so glad for all the meds I packed. If anything, I just hope I have enough of everything to last me. Today was the first day I felt near normal. Five days ago, I started to feel worn out and a little achy. I chalked it up to the long, rough rides from place to place out here in the field, long hours, and maybe “that time of the month.” Ha. By the next evening when my driver dropped me off at my hotel late in the evening, I started experiencing severe chills. I had barely enough in me to make myself take a hot shower (thank goodness I was in Meru where the hotel is pretty decent). Then I collapsed under the covers in bed. I finally dropped off as somewhere in my befuddled mind I worried that despite faithfully taking my mefloquine (antimalarial) prophylaxis, I’d somehow (thanks to constant mosquito bites despite DEET) contracted malaria – great. I awoke a couple hours later feeling extremely hot. Now, I really started to worry. Eventually, I dropped off again. The next time I awoke, I felt neither chilled nor heated but instead, waves of incredible stomach cramping…followed by the need for the inevitable. I haven’t spent such an awful night in…..

The next morning, I downed copious amounts of loperamide (aka imodium), bismuth (aka pepto), and 2 gm metronidazole (this, at the strong recommendation of my WHO local colleague; although I had been inclined to take cipro – he insisted the former was the treatment of choice here) took some toast and tea for breakfast and met my driver for the horrendous ride to Tharaka to go help them in the polio immunization campaign. Somehow, despite a very touchy and queasy stomach not helped by sometimes roller coaster-like rides over the so-called roads, I made it through that day (my driver, sensitive to how I was feeling, tried to take some of the roads slowly and said later that I looked pretty awful – great; I really felt like death warmed over) .

The next night was only slightly better in that I didn’t suffer chills or feel overheated, but I had a fitful night thanks to constant searing stomach cramping despite having taken meds. The next morning I decided just to be on the safe side and started myself on a course of cipro – you know, being a doc and knowing the potential differential diagnoses is not always a blessing.

Who knows if the metronidazole or the ciprofloxacin worked to improve my symptoms faster? All I really care about is that I’m finally starting to feel something close to normal. The thing that worries me is that I’m only a few weeks into my three months here, and I had thought I was being so careful. Of course, there are a number of possibilities where and how I could have picked up the bug despite my cautiousness…the water I shower with despite being careful to try to keep it out of my mouth, the meals despite being mostly cooked or peeled fruit – still not a guarantee, and, of course, any one of the many kids with whom I’ve come in contact through my work here are just a few possible sources.

I really hate being sick.

Rift Valley Fever and other maladies

There’s a lot of talk here about Rift Valley Fever. Not as much as the talk about upcoming Presidential elections and not so much that it’s constantly in the media, but it’s enough of concern such that for a country who’s staple diet is usually beef and ugali (a corn-based starch), many people are foregoing eating beef or other livestock and eating now only chicken or fish. It doesn’t matter that there is beef that has passed inspection and been approved for consumption or that the virus can be easily inactivated by thoroughly cooking the meat. People don’t want to take chances, and neither do restaurants really want to risk someone getting ill and claiming that they got ill because of the meat the restaurant served.

There is currently a ban on the slaughter of livestock in many areas, and that, in itself, is affecting many people here. Tending livestock (cattle and goats mostly) is the means of survival, not just a living, for many people in rural areas. And for the Maasai, ritual livestock slaughter and the use of such blood is a necessary part of their culture. So many here are loudly grumbling about the ban and about Rift Valley Fever. People joke that the cows and goats are happy now because they’re safe and getting a chance to grow older, while all the chickens must feel doomed as they are targeted for dinner tables – at least until avian flu hits here. Then, the only safe (relatively) thing to eat will be vegetables, so everyone will become vegetarians. Actually, I’ve heard some voice their concern that if people aren’t able to begin slaughtering their livestock as usual, they will have to endure even harder times as they won’t have a means to survive and they will have to figure out how to feed their larger than normal livestock in country that is already limited in good grazing areas for cattle.

Rift Valley Fever can also be transmitted by mosquito bites, although not as commonly as through close contact with infected livestock and their bodily fluids. Still, it’s something that crosses my mind as I note that despite the generous eau de toilette of DEET that I apply every morning, I seem to continue to collect plenty of moquito bites. >:P I’m just glad for my mefloquine, especially when I visit so many health facilities and note in their registers the number of children seen and treated for malaria. Of course, I’d feel a lot better if the mosquitoes would quit using me for their haute cuisine.

By the way, I just want to mention the inanity of American insurance companies and drug stores that limit one’s prescription to 3 months supplies despite their being told that one needs a supply for a specific period of time. I had a nasty shock when I looked at my mefloquine and thought it didn’t look like quite enough. Sure enough, only 12 of the 18 pills I need for appropriate malaria prophylaxis had been given to me. (Mefloquine is to be taken one pill weekly starting one week before going to the area of exposure and continuing for four weeks after returning.) With my current supply, I’ll be taking my last pill 3 weeks before I return home. Yes, I should have counted the pills prior to leaving, but since the pharmacy saw fit to inform me that they wouldn’t fill more than 3 months supply of another prescription, I had assumed they would do the same for any other – ha! Well, I’ll figure something out. Diane thinks she may have two extra pills than she needs, so that would cover me until I return, and then I could get the necessary four more pills as soon as I return. >:P Stupid third party payors.

Adapting

I woke up this morning in my very modest Mwingi accomodations (The Mwingi Cottage Hotel – touted as the best and most expensive at Ksh1800 – just under $26) to find I’d inadvertantly partly stepped on a cockroach. Ack! At least I was wearing my slippers. Turned out I’d only stunned it – must have just stepped on an edge of it and somehow managed to make it flip over on its back. I was so glad that Diane had suggested purchasing the can of Doom (think Raid) in Nairobi before we left for the field. Rifling through my suitcase, I quickly found it and tried to remove the lid as I nervously watched the cockroach begin to slowly stretch and wiggle its legs as it tried to right itself. Damn, the lid was jammed on tight! (I later learned from my driver that the lids on these spray cans are notorious for being difficult to remove – great.) I finally got it off and sprayed the hell out of the disgusting bug. So much for “new and improved fast kill formula.” I had to spray the thing several times and finally continuously for 10 seconds before it finally died. Ugh. I hate bugs, especially roaches.

I assume that thing came up my shower drain, which happened to be, in this hotel, basically an open hole in the corner of the bathroom – no cover. Oh yes, and again, like the hotel in Nanyuki, the shower was not separated but continuous with the toilet and sink in a room. I suppose the roach could have come in through the slightly open window I couldn’t close because of the permanent but torn screens on the inside of the windows. The previous night, I’d seen a small gecko on the curtains – so much for doing his job of cleaning out my room of bugs.

Since leaving Nairobi, as I hop from place to place in the rural countryside, I can’t help but chuckle that my expectations for an adequate place to sleep are changing. Most places are on the dingy side and have plaster and paint coming off the walls, windows that don’t close properly or at all, torn mosquito nets if any, cracked tiles (if there are tiles) or unevenly painted concrete floors, old and usually weak lights, sometimes inconsistent power, sometimes lukewarm showers, etc. I’ve learned to adapt to the foam pad mattresses and flattened foam pillows or torn and worn towels as long as the place is mostly clean with clean sheets. Forget about fulfilling all the security requirements we were advised by the UN security officer – ha! I wonder if some of the doors I’ve had on my various rooms would actually be able to stand up to any true force – one looked a bit warped with the top portion “bent” or warped inward enough to see a very small crack of light at the top left corner.

Still, as bad as things may sound, my situation could be much worse. I’m actually lucky and have it pretty easy compared to my colleagues, I think. For the most part, I’ve had power, most of the lights have worked, and I’ve only had to endure one chilly shower so far (knock on wood). Every place I’ve stayed serves breakfast (usually “Spanish omelette,” toast, a small sausage that tastes more like a hotdog, some fruit [the kind with peels, of course], and milk tea – ack, I’m running low on lactaid tabs already) and provides a reasonable dinner. Thank God for my Ipod in terms of entertainment and sanity at night. Of course, I’ve had no internet access, but still, I’ve not had to duct tape my toilet together (OK, in one place I had to use a liter bottle to tediously fill up the tank so I could flush it) or see five inch long scorpions in the hallway outside my room (knock on wood – only cockroaches, locusts, and insundry other smaller bugs so far, although not really a comfort there) or feel stifled in unremitting heat (well, in Mwingi, my room was a suffocating hot box unless I turned on the “air conditioning” unit, which made such a huge racket that getting to sleep was difficult and staying asleep was a challenge) – those alternative unfortunate conditions are some of the things Diane has been dealt where she is now up in the northwest portion of the country in Turkana. (Thank God, we have cell phones to keep in touch, compare notes and advice about our work, but especially, to commiserate.) Most importantly, what has made my “safari” (Kiswahili actually for journey rather than the connotation we Westerners have attached to it) bearable and even pleasant is that just about every Kenyan I’ve met, whether through my work or in the hotels, has been gracious and friendly. Warm smiles can go a long way.

On running

Kenyan runners are world renowned for their prowess in distance running, so my friends had teased me about meeting up with some Kenyan runners for a morning run. Actually, although in the big hotels in Nairobi, there are plenty of Kenyans using the gyms to work out and run on treadmills, there are only some parts of Kenya (mostly the west according to one Kenyan I’ve talked to) where runners on the roads are not an odd sight. Here, running is viewed, for the most part, as a lucrative sport that could offer an individual a way out of poverty and hardship – much the way American youths might view basketball or football. Very occasionally, one might see youths running on the roads, presumeably for secondary school team practice according to my driver; and usually, they don’t have shoes on – yeah, they’re running barefoot; most in the rural areas (much of Kenya) can’t afford the appropriate shoes.

For most Kenyans outside of the few cities and even within them, running just for daily exercise is somewhat odd. Then again, many of them inadvertantly exercise every day because, especially in rural areas, automobiles and other motorized transportation can be hard to come by, and most roads are either in poor condition or lack any asphalt (i.e., are just dirt and/or stone). So, oftentimes, if you want to get somewhere, you have to walk, even if it means walking miles in the hot sun.

So, although I’m managing to get in an early morning run most days, I draw plenty of curious looks. Of course, that could be partly because, for security, I usually run within the hotel grounds, which can mean going round and round the often limited courtyard, like a hamster on a treadmill.

Two flat tires – Nina pancha

Another long hot day on bumpy roads. Americans and others take much for granted. Kenyans walk everywhere by necessity. More Americans should walk…

To sum up the day…

Arrived at Provincial Ministry of Health offices to touch base with provincial health officers.

Set off for Tharaka, rural district ~2-1/2 hours away or somewhere ~100km, carrying some public health materials (e.g., posters and disease reporting forms).

1-1/2 hours into bumpy, hot, and dry drive (Maui red dirt is nothing compared to Kenyan roads that haven’t been “tarmacked.”), first flat tire – left rear. Oh dear.

20 minutes later, after changing and being gawked at by some locals gathered around my driver and I, on the road again.

Arrived at Tharaka district health offices. Introductions. Discussions regarding polio immunization campaign. Offered assistance to district health officers.

Back in 4WD with one district health officer to take polio immunization campaign posters to areas around district and help with “sensitization” (i.e., public health education). One of several stops: parent-teacher conference (a couple hundred people, at least, all gathered in a great circle outside on field by a primary school – attendance puts any American PTA/PTO to shame) – a little daunting, but also pretty cool to be able to take advantage of their meeting to announce the campaign.

Going back to Tharaka district health offices to drop off officer and touch base with district medical officer, another flat! Same side – left rear! By the way, outside temps 40-41 degrees C plus unpaved, very uneven and occasionally rocky roads – burst tires like balloons. Oh, and running low on gas.

Getting late, although still a couple hours from full dark, but still one hour from district health office and 2-3 hours from Embu afterward – had been advised not to travel after dark. Oh well. Also, now without any spares. Ack! The UN security guy who briefed us in ATL training would be shaking his head.

But, all is not lost, fueled up when dropping off one district health officer and picking up another who needs a lift to Embu. Serendipity. More company on the ride – always good. And thank God have cell phone – called for another spare from Nairobi so will be OK for further travel once back in Embu. So, make it back fine.

Settling back in hotel. Dinner waiting – hotel chef prepared for my return (hotel staff have taken me in – home sweet home). One last thing – Embu with interrupted power, so hotel running with limited power by generator. Thank goodness for headlamps and handy pulsar LED light. Thank goodness for Ipods (only two channels on TV anyway).
What a day. Time to sleep. [sigh]

Giraffes sighted

After the long day on Friday, I had an unexpected respite – the weekend off. As this is likely to be rare, my driver and I decided to make the most of it and visited the nearest game park, Sweetwater Game Reserve at the Old Pojeta Ranch a few hours from Embu. We spent an enjoyable Saturday afternoon driving along the tracks in the preserve and sighting various animals including zebras, giraffes, different species of gazelles/antelopes/etc, warthogs, and rhinos. We even got to see chimps – although not native to Kenya, there’s a chimp orphanage that was established by the Jane Goodall foundation. Unfortunately, we didn’t sight an lions, elephants, or hippos, but that’s OK since I’d already seen plenty of those when I’d been on safari in Tanzania a few years ago (check out my last blog www.sparktravels.blogspot.com for those details). Anyway, the rhinos made up for not seeing the others. In Tanzania, I’d only seen one from a great distance. This time, I got to see three quite close. One of them, a black rhino named Morani or Rani for short, is even tame – tame enough that he lets people walk up to him to touch and pet him!

Driving all the way back to Embu would have been pretty long, so we'd booked rooms at a place recommended in Rough Guides Kenya. The place, called the Equator Chalet, was in the town of Nanyuki. In case it’s not obvious, the area sits just around the equator – to be more specific, Embu is just south of it, while Nanyuki is just north of it. Anyway, the Equator Chalet was at least clean and did have private bathrooms and hot showers as well as a dining area where one could get dinner and breakfast. Otherwise, it was pretty bare with conditions that would surely make the UN security officer who briefed us in training raise his eyebrows. All the rooms had windows and doors along main corridors that opened out to an inner courtyard – if you’ve ever stayed in a Best Western motel, the style is similar, although at least these rooms were a few floors above the street. The wooden door had old fashioned keys and keyholes (quaint) and ended just about a couple centimeters above the floor – just enough for insects like dark locusts and whatever else to crawl under as they were attracted to the light. Thank goodness for duct tape – makes a great bottom door flap to keep the buggers out. Given the bare minimum security, I was glad of Diane’s husband’s gift of wooden door stoppers to help keep the door shut. Unfortunately there wasn’t much I could do about the inadequate latches on the windows. The bathroom was interesting – the shower, toilet, and sink were basically all contained in one cramped room with no divisions. This was an interesting and weird experience. But, again, at least the room and bedsheets were clean, and dinner was decent (although I’m discovering that Kenyan chickens seem to be a bit tougher and much leaner on the bone – by the way, thanks to Rift Valley Fever, there’s no beef to be had anywhere – i.e., massive culling ongoing to stem that). Security was not really an issue; what was an issue, was noise. It was Saturday night in a town that is located near a Kenyan Air Base and a British training base. Oh well, one can put up with most things for one night.

Sunday, we decided to have a closer look at Mt. Kenya. Given lack of time and gear, we opted to drive as far as we could from the Sirimon Gate up to Old Moses Camp, about 3300m. This route affords a good look at the rainforest fauna and flora. Had we started up at a much earlier hour, I suspect that we might have come upon some elephants – there was plenty of evidence of them on the road. At Old Moses Camp, we got out and hiked a little ways and enjoyed the cool fresh air. There’s something about being on a mountain that’s just so awe-inspiring and so peaceful. I only wish I had the opportunity to climb to the top – another time maybe.

Now, back in Embu, I prepare for the busy week ahead of me. The cell phones Diane and I purchased have been a Godsend. Without this cell phone, it would have been pretty difficult to communicate with others and plan for the week. Secondarily, it also helps me feel connected with my colleagues in the field. Ironically, although I'm still the closest to Nairobi, our main home base, I seem to be as isolated as the others. No convenient internet access here in Embu, whereas Diane can just walk across the street where she is in Nakuru, thanks to the fact that it’s a touristy location. Funny how things turn out.

First real day

Well, on Friday I began to see one reason why some joke that this consultancy could be a form of weight loss program aside from the obvious fact that most of us are exposed to foreign and sometimes unusual diets that are also often limited in options. The day started early as I got up to run around the length of the courtyard like some odd human hamster. Hey, it’s a workout. Being up so early allowed me to bid Chidi farewell as he and his driver began their long and bumpy trek up north.

After a hearty breakfast (a "Spanish" omelette, toast, a little bacon and sausage, the latter tastes more like a hot dog, fresh fruit, cereal, and tea – OK, that’s not the part that leads to the weightloss), Chesang (my WHO-Kenya counterpart) and I started our day together, but then soon had to split up to cover all the health facilities we intended to visit to assess their disease surveillance activities and offer recommendations to improve those activies. I’m sure Chesang’s day ran pretty much the same as mine.

The distances and poor-fair road conditions between facilities demanded that we not stop and travel from one to the next, so my day stretched over lunch and into the evening – i.e., no lunch and no chance to pick up something to drink. Obviously, finding a bathroom never came up because I was too dehydrated to need one – just as well, we didn’t have the time. Anyway, next time, I really should have some water – imagine me overheating, dehydrating, and fainting. It’s enough that I constantly draw curious stares – well, I am a lone Asian among all these Africans, and I’m hanging out in the countryside where these people would be even less likely to come across someone like me. It’s actually not any hotter here than it might be in Hawaii on a hot day, but picture dry heat and no air conditioning and sitting in enclosed areas with little wind or ventilation. Definitely have to remember some water next time.

Visiting these health facilities was really as much of a learning experience for me as it was (I hope) for them. Based on my own knowledge and experience and the recent training in Atlanta, I tried to help them examine their surveillance activites from a different point of view and hopefully offered some new or different ideas that they could implement or could use to stimulate their own ideas so that vaccine preventable diseases can be better detected, prevented, and controlled here. For my part, I reflected that the people and the relationships here really are not that different from those in Hawaii. As I assist in the public health activities here and in the upcoming mass polio immunization campaign here in Kenya, I find myself thinking occasionally about how some of the things I learn and observe here might be useful in Hawaii, especially as we are also planning a targeted mass vaccination there (albeit against flu rather than polio)…

Aside from public health, as a clinician, I find myself also interested in the clinical capacities of the health facilities here and the marked difference in healthcare delivery here compared with the U.S. or any western or industrialized country. How lucky are we to have the high level of care that we do? The facilities here are often lucky if they even have one doctor but usually depend on clinical officers (kind of like physician assistants) and nurses; and the wards are strictly bare minimum with no ventilators, imaging capability, or any sophisticated monitors. If anyone required anything of that standard, they would have to be transported (if they were lucky) to Nairobi. People in the U.S. may complain about busy waiting rooms and U.S. doctors may complain about being overworked, but they should see the mass of people here waiting for hours on benches and wherever there’s room out in the heat. I’m told that market days (usually Tuesdays and/or Fridays) are the busiest since that’s when many can catch a ride in from the surrounding countryside or need to make the long walk to come to market. It’s amazing given the great difficulties with healthcare access here that as many children receive immunizations as they do. Kudos to the Kenyans.

Hii ni barabara kwenda Embu?

Well, here I am in my modest and clean lodging in Embu, the seat of the Eastern Province. It’s good to finally be out in the field. Nairobi was interesting with all the sites, sounds, and smells of any major city, but it’s still a city with all the craziness, pollution, and yes, crime (especially carjacking, which apparently is common in this city and requires that one keeps car doors locked and windows rolled up) that goes with that. Now that I’m in the countryside, I find that I have missed the quiet and exhaust-free air, and listening to Iz on my Ipod, I find myself thinking of home in Hawaii and all my friends there – not quite missing it (too soon for that; by the way, Malia, you can tell your boys that I haven’t seen any wild animals…yet).

Actually, what I do miss is running outside. Fortunately, the Stanley Hotel has a gym, which, although not air conditioned, provided a place for me to run every morning. Funny thing is that when I first got on the treadmill, I initially couldn’t understand why I felt like I was struggling so much to maintain my usual running pace. Then, it hit me…duh…aside from the fact that I was jetlagging, Nairobi is at an altitude of 1700m. Now, in the Owoods Lodge Annex in Embu, I am looking forward to, well, not exactly running full out (as my sister has pointed out, a lone Asian female running on the roads in Kenya sticks out like a sore thumb), but running back and forth along the maybe 75-100m of walkway and stairs (see picture) in this little complex. Hey, at least, I’ll get exercise, and I’ll be outside, although the lodge staff and guests may think I’m odd.

Our team awoke this morning not quite sure if we would be heading out to the field yet. We had all agreed that we should be ready and packed in case we did head out, but we delayed checking out. As it turned out, when we got to the WHO offices, it was quickly evident that we were scattering today. All our 4WD vehicles and respective drivers were there in the lot. Since Diane’s and my cars were to be rentals with hired drivers, we had to check out the cars with the WHO drivers to ensure that our vehicles, especially Diane’s, were in good condition. I may not see as many of the wild animals that my colleagues will see on their long journeys out to the field, but I won’t require an armed escort or VHF radio (UN security regulations for phase III areas – i.e., Kenya’s border areas), and I’ll get to enjoy the comforts of a more traditional SUV with air conditioning and likely better accomodations (my mom will be happy to read this, I’m sure). Diane’s vehicle looks like one of those old gigantic safari vehicles. Well, I may not have to endure as rough conditions as the others, but my shorter trips will take me to places with greater population density than my colleagues’ areas. So, I won’t celebrate my “good” luck just yet.

During the few hours drive to Embu, I enjoyed some interesting coversation with my driver Joseph as he answered by questions about Kenya, the people, and the languages, especially Swahili. We followed Chidi and his driver Kidome in their 4WD UN vehicle along the mostly decent highway; Joseph says the roads we’ll have to traverse will mostly be good, but a few areas will not be so good…but not nearly as bad as what Chidi and Kidome will have to travel. Those two were to overnight here with us before they continued their long journey farther norther up to the Kenya-Ethiopia border. We made one stop along the way here at one of the roadside fruit stands where Chidi and Kidome playfully insisted that I must also buy some fresh mangoes to ensure that, as they would, I would be able to get my vitamins by eating a fresh fruit every day.

We arrived at Embu initially intending to stay at the Izaak Walton Lodge, only to find that it was fully booked. Oops. Fortunately, the modest lodging down the road had just enough rooms for us and our WHO field counterpart Chesang, whom we met at the first place. The entrance to the Owoods Lodge Annex might make some (like me) raise their eyebrows initially – a couple of small elephant figures flanking the safari-stylized entrance, but inside, it’s actually quite simple and, more importantly, clean.

So, now, on my foam mattress bed on clean sheets under my mosquito netting, I’m happily settling into my first night in the field after having enjoyed earlier a satisfying and actually quite tasty dinner of chicken curry with rice and sauteed vegetables and having been able to do some needed handwashing of some clothes(thanks for the clothesline, Kate!). We’ll see what tomorrow brings.

And the adventure begins

Arriving at the Atlanta airport on Saturday, Feb 3rd, I joined some of my fellow STOPers; a number of us assigned to African countries would share the first leg of our journey to Amsterdam, where we would then split up. It was a nice way to start our assignments. I’m sure we seemed a bit of a curiosity to most other travelers: a group of African men, an Indian woman, a Pakistani women, and one Asian American…with the occasional visit from our German colleague, Konrad, whose flight to Germany (his duty required him to fly to his assignment, i.e., Pakistan, via his home country) was leaving around the same time a couple of gates down from us. ( By the way, apparently not only do internationals entering the US have to register at a “Visit Kiosk” where they get their passport and fingerprints scanned and receive a”very important” receipt, but now they have to also do this prior to their departure. On one level, I recognize that this is the unfortunate consequence of the now not-so-safe world in which we live, but on another, it just seems unfair and paranoid.)

Anyway, as it turned out, one of my new friends, Ali, had to travel back to Kenya to secure a VISA through the WHO-Sudan/Somali office in Nairobi on his way to assignment in Sudan. So, I had some good company…sort of (our seats weren’t near each other)…during the journey to Kenya. Seeing a friendly face and having someone with whom to endure and commiserate over the long travel and the anxious wait at the end for luggage was great. Ironically, I got my bags, no problem, while one of his bags was one of the last to offload. He almost missed it too b/c the gorilla handlers had put it face down, and as it was a new bag, he didn’t recognize it until I pointed it out to him based on the description he’d given me.

As I walked out of the terminal with Ali, his friend found him, and I found my hotel driver bearing a placard with my name. Perfect. So now I’m finally here in Kenya. The streets were pretty quiet and empty, but as my driver pointed out, it was Sunday night – rest day. He assured me there would be plenty of traffic during the week. He wasn’t kidding, as I saw the next morning. Also, I didn’t realize, but apparently Kenya follows the British driving system – i.e., steering wheel on the right hand side and driving on the left side. Disconcerting, especially since, despite the heavy traffic, there are no traffic lights at intersections! Good thing I don’t have to drive in this constant complicated weave of hurrying people and motoring vehicles venting heavy exhaust.

Feeling a bit jetlagged (Diane, my Canadian colleague also assigned to Kenya, especially so, since she arrived that Monday morning after about 36 hours of grueling travel from Canada via London and very little sleep), we and two other WHO short term consultants (STCs; Carry, from Holland, an older woman with a nursing background who seems to have been everywhere through cycling and through the short term assignments she does for WHO and MSF and Chidi, originally from southeastern Nigeria, a medical doctor, and also a serial STC with WHO) were picked up by a WHO driver at our very secure hotel (there are security guards everywhere and the driveway is gated – apparently this is a very popular UN and ex-pat hotel) to meet our WHO field supervisor and find out what was expected of us in the coming months.

As we begin the briefings, orientations, and other necessary preparations for field work, we also find some time to enjoy a little down time to recover from the jetlag, get to know Nairobi a little, and even begin sampling the local food (lots of chicken and starch – especially Ugali, a cross between corn meal, polenta, and corn bread, very plain, and requiring a stew or sauce with which to eat it). In general, people seem very friendly and helful here. Of course, one has to watch out for those folks trying to hit up foreigners for cash “for a good cause” or guys trying to get you to go on a safari tour with their company. (Diane, unfortunately, seems particularly prone to these; of course, being quite obviously blonde and fair-skinned makes her a lovely beacon.) This city is very crowded! It really seems to be a maze of people and cars during the day. Although Kiswahili is the primary language, one can hear sprinklings of English words or conversations in accented English, and many products (some American brands) sold in the supermarket bear labels in English. There are also plenty of cell phone stores and internet cafés. Diane and I decided to try one of the latter. Unfortunately, it seems that while cafés for internet access abound here, it’s also incredibly slow (you could watch the grass grow faster than the internet works here – maybe it was the particular time of day) and when we tried to use it, it seemed to also have gone down – and not just at one place but also another one a couple blocks away.

Oh well. We are in Africa. And soon enough trying to find internet access won’t matter as we go out to the field…at least not till we return near the end of the month. We start the adventure tomorrow, as our team scatters throughout Kenya by 4-wheel drive vehicles to support the polio immunization campaign scheduled for the middle of February.

STOP Team 24

I'm currently in pedestrian unfriendly Atlanta, where I and the rest of the WHO/CDC/UNICEF team are going through our requisite training to inform us on the latest about polio and some other vaccine preventable diseases, how surveillance is or should be performed for these diseases, objectives of immunization campaigns and surveillance, basically everything we'll need to know (if we don't already) to be able to assess and make recommendations about surveillance systems primarily for polio (or acute flaccid paralysis) and immunization activities and especially, help our in-country partners in their efforts to eradicate polio and eliminate other vaccine preventable diseases. We've also received some requisite CDC and WHO/UN security training where they scare the bejeebers out of us...OK, not really, but some of the stories they tell do raise some eyebrows and some concern. It's probably serendipitous that I was reassigned from Nigeria: it's the only country that won't accept a UN passport (all the rest of us have been issued one - pretty cool); you have to use your own personal passport in Nigeria, meaning you don't have the usual, more obvious UN protection, I guess - although that can be relative depending where you are.

STOP training is actually otherwise interesting, and I've met many interesting and great colleagues from other countries. Some have never been to a western country or even outside their own countries, although many have been heavily involved in their own countries in polio surveillance and immunization activities. My roommate (yes, we all, or most of us, have roommates - I suppose to promote cultural exchange) is a doctor from Pakistan who is completely new to the US and anything outside Pakistan. The experience has been an eye opener and a learning experience for the both of us. She's been assigned to Nigeria, where I think, despite her inexperience internationally, she may do OK as she is Muslim and much of the polio activity in that country is occurring in the northern Muslim areas.

Our days tend to be a bit long. Sitting all day in lectures and case studies is somewhat taxing to the brain; thank goodness I can manage to run in the early mornings before we start, but it takes a lot of will power given the freezing temps. I had to get long running pants at the REI store down the street and am wearing all sorts of layers including a pair of socks on my hands to keep them warm. My now Hawaii-thinned blood isn't used to this 20-30 degree F business. I have to thank my Hawaii running friends Ed & Carol, too, for inadvertantly teaching me how to make the most of my surrounding neighborhood for running. Atlanta's infamous for hardly any sidewalks and almost no shoulders on the road, and my hotel is not exactly in a prime location - a corporate or business park area. So I've been managing to put in an hour run in the mornings by running around the perimeter of every parking lot in the immediate area. It's tedious, but it works.

I have to also thank all my ATL area friends who have rescued me every night so that I can enjoy some good eats and great company (although my new STOP friends make great company, too!). I've had a great time catching up with many old friends - a nice inadvertant perk of the STOP training.

After having spent a week and a half in training, I'll be off to Nairobi, Kenya this Saturday afternoon (ATL time) where I'll hopefully have some email contact. Three of us have been assigned to Kenya. Other than me, there is also Diane, an amazing Canadian who has already been on two previous STOP missions to Afghanistan and Sudan, and Mohammed, who was unable to attend the training with us here b/c as a Pakistani male he apparently encountered a lot of red tape in trying to get a US VISA. He's supposed to meet us in Kenya, we hope. Anyway, the plan is that we start in Nairobi, where we'll be briefed and oriented by the WHO staff, and then we will be assigned to the field, likely in the Northeast/East part of Kenya among the Somali refugees and displaced persons camps where much of the polio activity has been (and where the travel guidebooks have little to say - big surprise, not exactly tourist areas). Thanks to Samuel and Violet, two Kenyan colleagues who are on our STOP team and have been assigned to the Philippines for their mission, we have some good advice and recommendations for where to stay and who to look for as well as some good information for in case we actually have a little time for some fun along the way.

Well, guess the next post will be from Nairobi!