18 August 2011

DoD and Global Health

I just stumbled across an interesting article on U.S. Department of Defense efforts in global health and infectious disease. I thought it was particularly interesting since I'm currently working within one of the overseas laboratories it mentions.

Shedding light on the Department of Defense’s little-known contributions to global health
By Meredith Mazzotta

The U.S. Department of Defense might not incite thoughts of contributions to global health, but a briefing Thursday on Capitol Hill – hosted by The American Society of Tropical Medicine and Hygiene (ASTMH), Center for Strategic & International Studies (CSIS), Research! America and the Sabin Vaccine Institute (SVI) – shed new light on that thinking.

“The Walter Reed Army Institute of Research (WRAIR) is one of the largest developers of vaccines in the non-private sector,” said Peter Hotez, MD, PhD, president of the SVI and ASTMH, and a presenter at the briefing on DoD’s Essential Contributions to Global Health. “Most of the interventions that we have that we can use to fight neglected diseases in low- to middle-income countries are because of WRAIR.”

There are many reasons for that, according to fellow panelist Col. Kent E. Kester, MD – a former commander at WRAIR and a malaria vaccine researcher, scientist and soldier. “Our primary mission is force health protection – developing medical solutions to protect our deployed service members. If you have health threats that don’t discriminate between someone living in a small village in Kenya or an Army Corps of Engineers building bridges in country X, it has much broader implications and force health protection means much more,” Kester said.

What is more, “sick nations are dangerous nations – that’s a truism,” he said.

Hotez agreed, noting the “very intimate” relationship between tropical infections and conflict. “We can actually show that if you go to the countries with the highest rates of neglected tropical diseases, they were most likely involved in conflicts at some point over the past 20 years. Is it because these are places where there has been a lot of conflict and a breakdown of the public health infrastructure? That’s certainly true, but we think tropical infectious diseases have been shown to be highly destabilizing,” Hotez said.

The annual budget of the DoD is approximately $630 billion, .05 percent of which is going to produce some of the “most extraordinary interventions that are making a huge difference for bottom billion people who make no money, and at the same time they are having a huge potential impact on reducing poverty and conflict in low-income countries,” Hotez said.

The next challenge, panelists agreed, is to educate the public and the Congress about what we’re getting for that approximately $130 million annual investment. “The intimate relationship between disease and national security interests is an argument that needs to be better articulated than it has been to date,” Hotez said, and include how we are working to meet all the goals of the president’s Global Health Initiative, and take infectious disease research at WRAIR and link it to overseas labs.

“There’s no question that our U.S. servicemen and women rely on the work these laboratories perform,” said panelist J. Stephen Morrison, PhD, director of the Global Health Policy Center at CSIS, who issued a new report entitled The Defense Department’s Enduring Contributions to Global Health in late June. The global health benefits that are spread beyond the immediate target client base – diagnostics, vaccines, therapies, new knowledge – they’re a best buy… There’s not a lot of money going into these laboratories relative to the output, he said.

Some examples in the CSIS report of DoD contributions to global health include:


  • in Thailand, the first successful HIV/AIDS vaccine trial,

  • the demonstrated efficacy of Malorane, primaquine, and weekly tafenoquine to treat and prevent malaria,

  • lab research that resulted in the first vaccine for Japanese encephalitis virus (JE),

  • the first identification of new strains of dengue fever in Peru.

However, “The labs are under-resourced and under-acknowledged, within the DoD, on the Hill and in broader society,” Morrison said. He then outlined what is needed moving forward, including recommendations for modest adjustments in funding levels to create a balance where core research can be fulfilled, much better communication between levels [of government], better outreach to Congress and core constituencies, and cultivating champions to speak in support of them.

“All those steps can be achieved in the near and immediate term,” Morrison said.

14 August 2011

Health in the Horn of Africa

Health in the Horn of Africa: a collective response needed
The Lancet, Volume 378, Issue 9791, Page 541, 13 August 2011

"In 1984, the world said 'never again' to famine in Ethiopia. But, 27 years later, famine has revisited the Horn of Africa. Between July 20 and August 3, the UN declared famine in five regions of Somalia. The disaster is expected to spread to all eight regions of the country in 4—6 weeks and is likely to persist until at least December this year.

A famine can be declared only when at least 20% of households in an area face extreme food shortages with a limited ability to cope; acute malnutrition rates exceed 30%; and the death rate exceeds two deaths per day per 10 000 people. Deemed the “worst humanitarian disaster” in the world by António Guterres, the UN High Commissioner for Refugees, it has threatened the lives of 12 million people, and more than 29 000 children younger than 5 years—nearly 4% of children in Somalia—are estimated to have died. Malnutrition was already prevalent in about half of all children younger than 5 years who arrived at UN camps in Somalia, which made them especially susceptible to the complications of diarrhoea and measles. According to WHO, the number of people becoming infected with measles and waterborne diseases is growing at an alarming rate, and cases of severe diarrhoea in Kenya and Ethiopia are a serious concern. Furthermore, hundreds of thousands of refugees from Somalia have fled to neighbouring countries, in particular Kenya and Ethiopia, and the ongoing refugee crisis has raised the risk of diseases associated with crowding such as measles, diphtheria, pertussis, acute respiratory infections, meningococcal disease, and tuberculosis. Additionally, humanitarian organisations reported that women in the refugee camps faced a drastic increase in sexual violence, which has put them at high risk of contracting HIV/AIDS.

The UN is stepping up deliveries of food aid in famine-affected areas, and WHO has led an emergency measles and poliomyelitis vaccination campaign, together with the provision of vitamin A and deworming tablets targeting children younger than 5 years on the Somali—Kenya border. However, in view of the extremely fragile health systems and poor sanitation in these countries, the vicious cycle of hunger, ill health, and poverty makes the situation even more intractable.

There are many factors underlying the famine. The drought, the worst in 60 years, is the initiator of the tragedy. More than 95% of Africa's agriculture is rain-fed, and is therefore susceptible to climate change. On top of that, Somalia faces a security crisis as a result of political conflicts, civil war, and anarchy, which has meant that most of its people have lived in an extremely precarious state since its last national government collapsed in 1991. As the economist William Easterly once commented on Ethiopia's struggles with famine over the past quarter-century: “It's not the rains; it's the rulers.” The toxic politics should perhaps be regarded as the major culprit; the famine is more of a man-made disaster than a natural one.

The international community is also to blame for responding too slowly and neglecting its responsibilities in this preventable disaster. Despite the forecasting of the crisis from the Famine Early Warning Systems Network since November, 2010, the first aid flight did not arrive in Somalia until 8 months later. The UN issued its first appeal on July 20, and by August 3, the appeal was only 44% funded, with an additional US$1·4 billion still required to cover unmet needs. The USA, Europe, and other wealthy donors waited until pictures of starving children and desperate women made the evening news to hand over funds. China, Africa's second largest trading partner after the USA, merely said it would pay “close attention” to the disaster, and only pledged a modest $14 million of food aid on August 5, after US House minority leader, Nancy Pelosi, urged the country to do more.

In an era of advanced agricultural productivity and transportation networks, it is unacceptable that a famine has happened. It is even more unfortunate that Africa is still “a scar on the conscience of the world”, as former UK Prime Minister Tony Blair said 10 years ago. More and longer-term investments in agriculture and health in Africa are needed alongside a collective global response. Notably, China, which experienced one of the largest famines of the 20th century and yet has harnessed 7% of the planet's arable land to feed 20% of the population, should be more of a leader here and show that it has an interest in the welfare of Africa's people. Such a humanitarian disaster must never be allowed to happen again."

04 August 2011

Mubarak on trial

Yesterday marked the start of yet another historic event in Egypt, the trial of former president Hosni Mubarak. Throughout the morning - a time of day when normally, during Ramadan, few Egyptians would even be awake - the country was glued to live coverage of the trial on Egyptian state television. Even in the office, most people snuck off either to the cafeteria or to the gym, the two places within the compound that have televisions, to follow the news.

Highlights of the first day of the trial:


  1. Mubarak showed up. (Most people expected the court to issue an exception that would allow him to stay in the hospital in Sharm el Sheik instead of being transferred to Cairo.)

  2. The trial was not postponed. (Even once Mubarak showed up, many expected the trial to be dismissed or postponed, especially since it was to begin on the third day of Ramadan.)

  3. "After roughly an hour of lawyers who represent protesters making demands, including one who claimed that Mubarak had died in 2004 and been replaced by an imposter, presiding Judge Ahmed Rifaat has ordered all lawyers to take their seats." (I'm not even kidding. I couldn't have made that up if I'd tried!)

For more (serious) news on the start of the trial and peoples' reactions in Egypt, read more here.

01 August 2011

Friday of (Dis)unity

This past week’s protests in Tahrir Square were planned as the “Friday of Unity”, in which various political factions and parties would come together to present a united front in support of social justice, economic reform, judiciary changes, rights for the families of those who were killed in the revolution and other demands that have been heard repeatedly over the past five months. Instead, this day of protest proved to be the most divisive to date as conflict erupted not between the protesters and the military or police, but within the protesters themselves.

As tens of thousands filled Tahrir Square on Friday, Islamic groups - such as the extremely conservative Salafis and the relatively moderate Muslim Brotherhood - took to the square and outnumbered secular, moderate and liberal groups who have led the protests for the past five months. Familiar calls for justice and reform were overwhelmed by new demands for an Islamic state governed by sharia law. The show of might by these Islamist groups was so strong that many of the other groups who were meant to be involved in the protest left the square in the early afternoon, claiming that the day had been hijacked.

Some wonder if this Friday of (dis)unity is a sign of growing division and discontent in Egypt, as rifts between conservatives and liberals, military and civilians, Muslims and Christians, etc. seem to be deepening. For now, only time will tell.

19 July 2011

Continued revolution

When I was in the States in May of this year, I felt like I got a hard time from several people because I hadn't followed-up my last post about Egypt with a message that all is well. For those of you who are included in this group, all is well with my day-to-day life here in Cairo. I go to work, visit tourist sites, socialize with friends, shop, worship at church and go about the rest of my life just as I did before the revolution.

However, for the people of Egypt, all is not well. Protestors have continued to take to Tahrir Square each week since the revolution began. There has been "Save the Revolution Friday", "Friday of Cleansing", "Second Friday of Anger" (the first was January 28), "Friday of Retribution", "Revolution First Friday" and so the list goes on and on. The majority of these protests have been small, peaceful demonstrations by various factions who are unsatisfied with the transitional military government that has been in power since President Hosni Mubarak stepped down in February. However, there have still been spats of violence between protestors, "thugs" from the old regime, police and military forces.

Each week, it seems, the government must give in to one of the protestors' demands in order to keep peace in the square (and, for that matter, in the country). Interim policies have been put in place and government officials have been replaced numerous times. Just this week, nearly 600 senior police officers were fired. Still, the people are growing more and more impatient with the slow pace of change and the lack of prosecution against corrupt politicians and brutal police from the old regime.

The next few months should remain eventful - Former President Hosni Mubarak is set to go on trial on August 3; parliamentary elections are to take place in September; presidential elections are to occur before the end of the year.

While the degree of violence that overtook Cairo in late January is long gone and the situation is nothing like the crises taking place in Libya, Syria and Yemen, the Egyptian revolution is far from over. In fact, some say it's just beginning.

16 July 2011

Somali famine

The Horn of Africa, a region that includes Somalia, Djibouti, Eritrea and eastern parts of Ethiopia and Kenya, is currently experiencing the worst drought the area has seen in over 60 years. Somalia is the worst-hit country, due to a combination of difficult agricultural conditions, violent conflicts and militant groups that have deprived the country of national stability and any assistance that western aid organizations might be able to provide. Current estimates suggest that 3 million Somalis are on the brink of starvation and over 10 million are at risk across the region.

As a result, tens of thousands of Somalis are evacuating, seeking refuge at refugee camps in neighboring countries. Most are fleeing to Dadaab, the world's largest refugee camp, in eastern Kenya. Dadaab is currently home to nearly 400,000 refugees, but over 1,000 new refugees are arriving from Somalia each day, starving and having traveled for weeks to reach this possible safe-haven. To say this puts a strain on camp resources would be an incredible understatement. To give some perspective, Ali Addeh, a refugee camp in southern Djibouti where I've started some work, is strained by the arrival of 500 new refugees each month.

I feel like Somalia is one of those forgotten corners of the world about which most of us know little other than the Battle of Mogadishu (a.k.a Black Hawk Down), piracy and Islamic militancy (e.g. al-Shabaab). It worries me that a country with this reputation may not be able to receive the assistance it needs in the face of a drought that is as much a natural disaster as any earthquake or cyclone.

09 February 2011

Last days in Cairo

There's something about experiencing unrest and what may indeed become a revolution that brings me back to this blog. Since evacuating from Egypt a little over a week ago, I have been living in a cloud, in a state of limbo, in a blur of everything that has happened and is happening. A few days ago I forced myself to sit down and write the story of my last days in Cairo, which were the first days of the protests, in an effort to process everything that has been going on around me and create some order in the chaos of my memory. And so the story begins...

I knew that protests were planned for Tuesday, a mid-week holiday in honor of Police Day, but at this point I can’t even remember how I had heard about the scheduled demonstrations. Perhaps I saw an email was sent around the office by the U.S. Embassy suggesting that Americans avoid the crowds in Tahrir Square or perhaps I saw mention in the news or perhaps I saw a post from someone on Facebook. All I remember was a feeling of curiosity and calm with a slight sense that this might grow into something bigger. And so, as work drew to a close on Monday, I asked my boyfriend if he would stop to pick up some extra groceries after work. Just in case something came of this.

The demonstrations on Tuesday were significant and larger than many had expected. But now even their memory has faded into the haze that has taken over much of my memory of that week. On Wednesday we returned to work, joking in carpool that we hoped to encounter a group of protesters on the way to work so we could turn around and return home. The work day proceeded much as usual, though I did find myself checking Facebook and Twitter much more often than usual to try to get the latest scoop as what started as a single day of demonstrations continued onward. (Note that access to Twitter had been turned off on Tuesday by the government in an attempt to prevent protesters from organizing, but I still had access on my work computer.) I believe it was Wednesday afternoon that one of my colleagues received a phone call from her husband warning us that a group of protesters were gathering near his office and would be marching downtown – a route that would most certainly lead them right past our office. Although this news brought a sense of uneasiness, no one with whom we discussed the possibility seemed overly concerned. So we finished out the work day and returned home. The protesters continued their stand in Tahrir Square on Wednesday evening, but by Thursday morning their forces were dwindling.

Sometime on Thursday we learned that protesters were planning to re-establish themselves with a large demonstration after Friday prayers. Crowds would gather after mid-day prayers throughout the city to demonstrate against President Mubarak in what was being called a “Day of Rage”. An email was sent around the office advising that Americans stay away from mosques and from any places where people gather after prayers. Another email was then sent with an updated list of phone numbers and plans for notifying all office personnel in case of an emergency. And then, just before I left the office for the day, an email with a list of “what to pack in case of an evacuation”. At the time, I thought the office was being overly cautious and was just using the current events as an opportunity to update emergency and contingency plans. At that point in time, the thought of an evacuation seemed utterly ridiculous

At some point on Thursday, as I continued to follow Twitter and Facebook, I realized that posts about the current events in Egypt on Facebook had gone strangely quiet. It wasn’t long before I learned that Facebook had joined Twitter and other social media websites in being added to the list of websites that had been blocked by the Egyptian government. That mattered very little, though, when around 5:30 p.m., general internet access in Egypt was completely blocked by the government.

Yet life was still continuing rather normally. My boyfriend had colleagues from London in town and we had plans to take them out to dinner downtown. With the disappearance of the internet, I wondered if the situation might be growing more serious and if we ought to stay in our neighborhood, Maadi, for the night, but the rest of the group seemed unconcerned. And so our group of six met up at a friend’s place, loaded two cars and began the journey to Zamalek, an island in Nile in downtown Cairo. As we left Maadi and headed up the Corniche, toward Tahrir Square, I knew something was wrong. The roads into the city were empty. It was only 15 or 20 minutes before we were approaching Tahrir Square, which was probably less than half the time it would take to make that drive on a usual Thursday night. Just about a block before the square, we turned onto a side street so that we could then take the Kasr el Nil bridge to Zamalek. I strained my neck to look towards Tahrir Square, but could see no signs of the protests. All was quiet. And so we dined on the Blue Nile, a boat docked on Zamalek overlooking downtown Cairo, and all remained quiet. We then returned to Maadi, again with eerily little traffic for a Thursday in Cairo.

On Friday morning, the air was noticeably more tense. I woke up early and went to church, where the congregation was smaller than usual. As our pastor reached the point in the service designated for announcements, he told how upon arriving at the church earlier that morning, he saw one of the plain-clothes security guards who is normally posted to the church and who greeted him excitedly. “This is Mubarak’s last day,” he said. It was a shocking statement in many ways – that someone would have the courage to say it, that someone who is part of the government’s cadre of secret police would say it and that someone would have the confidence to think it might actually happen. The grave effect of those words left an eerie silence in the church.

After the conclusion of the service, we realized that mobile phone service had now been blocked by the government. No phones and no internet. The feeling of isolation began to appear. As we mingled with friends from church before going our separate ways, we realized we might have another issue at hand. Friday night was meant to be poker night for the guys and girls’ night for the ladies of our group. Although 14 of the ladies had r.s.v.p.’ed for girls’ night, without internet access to check the directions that had been sent out, few would know how get to the flat where we were meeting. And without mobile phones in service, the guys would be unable to place their pizza order for dinner. But there wasn’t much we could do, so we all decided to continue as planned. As the hostess for girls’ night, I needed to pick up some recipes from my house and then do some shopping. It was a strange feeling to leave the church on my own with no way to check in on anyone else, not being able to make a call or send a text message or have any communication to follow up on plans for the afternoon.

I wanted to hurry and finish my errands before mid-day prayers finished, but as I walked to my house, I heard the call to prayer ring out from the loudspeakers of the neighborhood mosques. I began to wonder what would happen an hour later when prayers drew to a close. I decided to pick up more than just a couple recipe books from my house – I packed a bag with a few clothes and some valuables. But I still had the feeling that I was being overly cautious and was trying to be prepared just in case of an emergency. As the mid-day prayers drew to a close, I managed to catch a taxi over to my boyfriend’s house where I was to host girls’ night. This was no small feat as the roads were almost empty. From there, I headed out shopping and found myself being overly cautious again as I decided to stock up on some food items. Again, just in case. I went to Metro market and bought extras of all the staples – eggs, juice, butter, flour, sugar, cereal – as well as ingredients for my dinner. I then stopped by my favorite fruit and vegetable stand for my usual produce – carrots, onions, melon, zucchini, tomato, lemon, lime, bananas. As I waited for my groceries to be packed, I looked toward the street to flag down a taxi. This street, which is normally bustling with Egyptians and with foreigners, was literally empty. What was most relevant to my particular situation, though, was that there wasn’t a single taxi to be found. I was thankful that the guys from my fruit and vegetable stand have been wonderful to me over the years that I’ve spent in Cairo and offered me a ride in their delivery car.

I arrived at my boyfriend’s place, unloaded the groceries, and noticed him sitting in the small park across the street talking with two neighbors whom we know from church. I walked out and chatted with them for a few minutes, during which they mentioned that their landline was still working and would make international calls. I decided to call my family in the States to let them know that I was safe despite the break in communication, and then I began preparing dinner for girls’ night.

At some point in this afternoon, we heard that a curfew had been put in place in an effort to clear the protesters from Tahrir Square. The curfew would be in effect from 7:00 p.m. until 8:00 a.m., throwing another kink in our plans for the evening. I continued cooking anyway, unsure of who might venture out despite the curfew, but probably also clinging to some sense of normalcy as the television continued to broadcast the scenes from downtown Cairo and across Egypt.

It wasn’t long before a few friends began to arrive. One couple arrived and had just come from downtown, on a side street by Tahrir Square, where they had been providing first aid treatment to the protesters who had been attacked by teargas and rubber bullets. They were supposed to have been working inside an acquaintance’s apartment, but instead had been refused entrance to the apartment and had worked in the lobby and stairwell of the apartment building, narrowly escaping confrontation with police who marched by in the street. Another couple, who live across the street, stopped by to see what we were planning for the evening. We made a decision that we would all eat and spend the evening together, despite curfew and despite our other plans. We all lived close to one another and could always stay in one apartment if curfew were being enforced. A fourth couple joined us and we settled in for a “revolution party” that consisted of “revolution imported wine”, “revolution homemade soup”, “revolution pastries”, “revolution Cuban cigars”, etc. At this point, early in the night, the mood was light. Yet as we ate dinner, we remained glued to the televised news reports from Al Jazeera and discussed what implications the day’s events might have for Egypt. As night fell, demonstrations were taking place across the country, and in places such as Suez, things were turning violent, but in our little enclave in Maadi, we were still enjoying the company of good friends.

Then everything changed. One of the neighbors who had been in the park earlier in the afternoon ran over and told us that a mob of protesters were headed to Maadi and the police had been given authority to use live ammunition on those who defied curfew. The apartment where we had gathered, with its huge front windows, large veranda and less-than-sturdy wooden fence, was a great place to live, but it was defenseless against a mob. Within seconds, the ovens had been turned off, valuable items had been gathered, lights had been turned on to give the appearance of someone being home, and we had run across the street to one of the couples’ third-floor apartment, which we felt would provide additional security.

There we continued to watch the news reports on Al Jazeera. We took turns on the landline calling employers, family and friends to check in and get updated information. We were nervous, but I doubt we yet felt the true intensity of what was happening in the country. We continued to drink “revolution beers” and smoke “revolution Cuban cigars”.

As we watched the news, the police had disappeared from the streets and the army had rolled in. They had been hailed by the protestors but had not obviously chosen whether they would continue to support the regime or turn and support the protesters. And that’s where the story of the “Day of Rage” ended. The army had arrived, but there was no conclusion. It felt unfinished. It was really just a pause, a hiatus, a moment of waiting to see what would happen next. Finally we prepared for some rest, spreading out on beds and couches and cushions throughout the apartment. As we tried to sleep, there was a bit of gunfire in the night, but it felt distant.

When I awoke the next morning, Maadi was quiet. I had slept longer than most of the group and learned that the boys had been up early to drive around Maadi with the pastor from our church. They reported that there were indeed tanks in the streets and a few burned-up vehicles in a traffic circle on the opposite side of the neighborhood. Everyone scattered to check on their own apartments and a couple of us set out to find one of our colleagues who had not yet checked in with the office. As we walked through the neighborhood, we could hardly notice that it was anything other than a regular Saturday. We walked over to my house, where I packed a few more clothes, hid a few valuables and filled up a bag with food from my kitchen. We then returned to my boyfriend’s apartment, where I showered and packed an emergency “go” bag.

One of the other couples then joined us and we set about packing food items, water bottles and extra blankets so that we would all be able to stay in the apartment across the street for a few days if needed. We then learned that one of the other couples who had been with us had moved out to a hotel near the airport and were waiting to be evacuated by their company. Those of us who remained rushed over to the designated apartment where we would all stay and settled in for the evening, continuing to watch the news and enjoying a large spaghetti dinner. A single friend who lives downtown soon joined us after having had a stressful day taking photographs in Tahrir Square. We made sure everyone was prepared with a “go” bag and settled in for the night.

Unfortunately this night was to prove much more harrowing than the previous one. It wasn’t long after dark that the gunfire began. The neighbors I mentioned previously joined us with their two sons and we were a packed apartment. We kept the lights and the noise low to avoid attracting attention, but the night was filled with gunfire throughout the neighborhood. We invited two single women who lived on the same floor of the apartment building to join us for safety in numbers, but they refused. We then barricaded ourselves in the apartment. The guys moved the refrigerator in front of the door, then wedged it in place with a mattress and two dining room chairs. We discussed contingency plans – what to do if someone came to the door, what to do if the building caught on fire (from a Molotov cocktail), what to do if the gunfire came right up to us. We spent much of the next several hours huddled in the hallway of the apartment, which was the only area away from windows and exterior walls.

At some point in the night mobile phone reception returned and a lot of phone calls were made – to family and friends overseas, to evacuation insurance companies, to employers, to friends and colleagues elsewhere in the city. It was a hectic night.

Eventually, we headed to bed, but it was to be a night of little sleep. I spent most of the night listening to the gunfire outside, planning what to pack if I were to have to evacuate, planning what to move from my place to someone else’s place if I were to have to evacuate, thinking up more contingency plans, praying for peace and safety, and wondering what the future would hold.

The next morning was a difficult one. As curfew ended, I ran across the street to my boyfriend’s apartment to take a shower and make a decision as to whether I would evacuate. His company had booked us both flights that were scheduled to leave that day at 1:40 p.m. I had no idea what to do. One couple was evacuating; two couples were not; a single friend was evacuating; my boyfriend was not. I was on the fence. It was just like every moment throughout this ordeal has been – unclear about the future with the feeling that things could either return to normal or turn disastrous in only a moment’s time. I returned to the apartment across the street, where our pastor and his wife had joined our group for a discussion about possible evacuations. The U.S. Embassy had not yet ordered an evacuation, but many companies were starting to send their expatriate staff away. By the end of the discussion, I decided I would go and, as I said the words out loud, I immediately burst into tears out of the emotion of it all. I then had only a few minutes to run back over to my boyfriend’s apartment where I had left the items I had already collected from my house. I packed a small bag with a couple shirts, two pairs of jeans, my cowboy boots, a small bag of toiletries, electronics and a few work-related documents, then grabbed my purse and stuffed several coats into the bungee cord on my duffle bag. In what felt like a matter of minutes, we were off to the airport.

As we drove out of Maadi, I started to question my decision to leave. Everything seemed normal. There was no apparent looting that had occurred on the streets we passed. However, as we approached the main highway out of the neighborhood, I saw the tanks, and the soldiers, and the looters who had been arrested and now stood with their heads hanging down and their hands tied. The scene made my stomach turn. We continued toward the airport onto the Ring Road, where the scene was much the same.

At the airport, I made it through the first level of security without much trouble. In the check-in area, the lines were enormous and there were people waiting everywhere. I went to check in for my flight and inquired about the line for business class passengers. I was only somewhat surprised when I received a response – “Today it is survival of the fittest”. It was a fair enough answer under the circumstances. I waited in line to check-in, thankful that there were airline attendants stationed at the front of the line, since many counters were unstaffed. However, when I finally made it to the front, I was told that my flight was not yet checking in. Although it was almost noon, the airlines were still trying to check in passengers from the first flights of the day.

I waited a bit and then remembered a separate business class check-in area at the opposite end of the room. I tried checking in at this line but was told the same thing. And so the pattern began – wait a half hour, try to check in, be told the flight isn’t yet being checked in. Finally, an hour after my flight was meant to have taken off, four hours after I had arrived at the airport, I was able to check in. I rushed through passport control and into the business lounge, where I met some friends who had been waiting for a flight that had already been delayed over six hours. They had been at the airport for eight or nine hours in total. We waited a couple more hours, becoming more and more convinced that our flights would be cancelled and we would have to stay overnight in the airport, which actually wasn’t a terrible option since the airport felt much more secure than our neighborhoods. Finally, an announcement came that my flight was boarding. I rushed to the gate and made it onto the plane just as they were closing. I breathed a sigh of relief as a settled into my seat, only to be told that it would be another thirty minutes before we could take off as there was no one at the airport to load the luggage onto the plane. The airlines were even shorter on personnel since the extended curfew prevented other persons from coming to/from work. Eventually we were able to take off.

I arrived in Milan long after my connection had been scheduled to depart, stayed the night in a hotel, and the next morning continued on my way to London. By Monday afternoon I was in a farmhouse in the English countryside.

22 June 2010

"Garbage Dreams"

Last night, I attended a screening of a film called "Garbage Dreams", which follows the lives of three teenage boys living in an area of Cairo called Moqattam. Because it is home to over 60,000 Zaballeen (trash collectors) who earn their living by recycling up to 80% of the garbage collected throughout Cairo, Moqattam is also known as "Garbage City". (See this post for photos from my first trip to the neighborhood.)

The film was incredibly interesting, examining the challenges the Zaballeen face as their trade is affected by globalization, particularly by Cairo's move to privatize trash collection through a $50 million contract with three foreign companies. It was both heart-breaking and thought-provoking.

The film was shown at a great venue called Darb 1718, a contemporary art and culture center in an area of town near Coptic Cairo. According to its website, Darb 1718 focuses on “(1) exhibiting the works of largely unseen local artists alongside those of established regional and international artists who have rarely or never exhibited in Egypt, (2) providing local artists with opportunities for international exposure and cross-cultural exchanges, and (3) implementing developmental programs that include workshops, debates, films and other educational initiatives.”

The film was shown outside, projected against the side of a neighboring buildling. The crowd that had gathered to watch it sat in orange beanbag chairs on the small grass lawn and on the roof of the building. It was certainly not a typical Egyptian evening, except, perhaps, for the oppressive heat and crowded Metro trains!

20 June 2010

Break from blogging

When I was back in the States in May, several people made comments about how much they enjoy keeping up with what I’m doing through this blog. Their comments reminded me that I should get back into the habit of writing and posting interesting stories, and I began to wonder what had led me to stop in the first place.

I noticed almost immediately that my blog posts trailed off right around the one-year anniversary of my time in Egypt. In that year, everything was so foreign and interesting – Islamic holidays, strange fruits and vegetables, trucks piled high with fifteen feet of God-knows-what wobbling down the highway, cases of H5N1 influenza, peaceful felucca rides on the Nile, even travels to nearby countries like Israel and Djibouti. Then everything was new. And strange. And fascinating. It was truly, as Paul Coelho writes, “an act of rebirth” in which “you confront completely new situations, the day passes more slowly, and...you don’t even understand the language the people speak.”

However, over the course of the first nine months of my second year in Egypt, situations are no longer “completely new”. Many things that were once strange and unusual have become routine pieces of daily life. Sights that I would have once photographed immediately and situations about which I would have loved to write and analyze are hardly notable. Thus blogging has become less of a priority.

While part of me feels like this familiarity could mean that it’s time to move on to a new country, another part of me recognizes that there is still much to learn and experience here, and perhaps I just need to pay a bit more attention to the environment around me.

As much as I would like to promise that I’ll revert to my former habit of regular blogging, I don’t think I can make that promise, but I do recognize that many of these things that have become routine for me may still be interesting to some of you, so I will try to continue sharing the more interesting aspects of this southern girl’s life in the Middle East.

08 March 2010

Guestroom improvements

In case anyone’s actually been following my home renovation projects, I thought I’d post a few pictures of my newly painted guest room. (Maybe this will encourage a few more people to visit?)

03 February 2010

"The wedding will start at 8:30"

“The wedding will start at 8:30,” she said. “Please be there on time.” She emphasized the latter phrase at least three more times before I hung up the phone.

On the surface, the request was simple enough. After all, I come from a region of the world where wedding guests are expected to arrive approximately thirty minutes before the event is scheduled to begin. There have been times when I’ve been scolded for not arriving a full hour before the scheduled time. So one would think that arriving at an Egyptian wedding “on time” would be no problem.

But this ignores the fact that this request went against everything I’d been told about Egyptian weddings. Although weddings are typically scheduled to begin at 8:00 or 9:00 at night, I’d been told that they never start on time and I ought not arrive any less than an hour or two AFTER the scheduled time! So it would seem that I should wait until 9:30 or 10:30 to arrive at the wedding, but the fact that she had placed such an emphasis on the time confused me.

I asked a couple fellow expats at work what I should do and they were as confused by the emphasis on timeliness as I was. Thankfully one of our senior scientists is an Egyptian woman who seems to always have the answers to these questions. Our conversation went something like this:

Me: If a wedding starts at 8:30, what time should I arrive?
Her: Between 9:30 at 10:00.
Me: What if the bride specifically asked me to be on time?
Her: (pause to think) Who’s wedding is it?
Me: The bride is a friend of mine, the daughter of my landlady.
Her: So do you know many people who will be at the wedding?
Me: Not really, just the bride and her immediate family.
Her: If it was a wedding where you knew a lot of people and wanted to spend time socializing, you should go at 9:30 or 10:00. If you aren’t going to know many people, wait until 10:30.

As my colleague seems to always be right in these situations, I took her advice and planned to arrive at the wedding at 10:30. However, while sitting in traffic en route to the venue, I started to worry – What if I was too early? Would I be sitting in a corner alone as the only non-Arabic speaker in the room? What if I was too late? Would I be an embarrassment to my friend? Would she be offended? Would I have to make up for my tardiness by staying until the very end of the event and not return home before 3:00 or 4:00 in the morning (on a Tuesday night when I would have to work at 7:30 the next morning!)?

I arrived at the hotel and entered the ballroom, and one of the first people I saw was the father of the bride (the husband of my landlady). He was thrilled to see me, stopped in his tracks, led me to a table at the very front of the room and sat me at a table with the bride’s grandmother and great aunts. As I sat down, I was relieved to see that neither the bride nor her new husband was seated on the stage at the front of the room. I was still early. So I sat and carried on a limited conversation with the older women, smiling and attempting to bridge the gap between our languages.

Within ten minutes, the lights dimmed, the music came on, and the bride and groom made their grand entrance. My timing really could not have been more perfect. The events of the night began and continued through the night. After the typical events of a wedding reception (signing the contract, exchanging rings, the first dance, cutting the cake, etc.) and lots and lots of dancing, everyone sat down to dinner, and I decided it was time to make my escape. It wasn't easy to sneak out - I had to say goodbye to about half of the wedding guests and make numerous excuses as to why I didn't need to eat a full meal of lamb, turkey, beef and fish - but I made it home and glanced at my watch as I walked in the front door. It was 2:30 in the morning - just three and a half hours before I would get up for work.

30 January 2010

Last travels of 2009

I've obviously been more than a little negligent with this blog over the past few months (more on that in a little while), so I thought I'd post a "quick" recap of my travels during the last couple months of 2009.

September: Ghana

After a day in Ada and a few days working in Accra, I was able to spend a weekend exploring the Ghanaian coast west of Accra. I spent a day in a town called Cape Coast, where there happened to be a festival going on, so the entire afternoon was spent sitting in the sun, drinking beer and people-watching.

Fishing boats on the coast
Crowded streets during the festivalLocal chief on paradeYes, we can!
While in Cape Coast, I also visited the Cape Coast Castle, which is an old European castle used during the transatlantic slave trade. It was an incredibly somber experience to tour the castle with a group of West Africans and to hear the history of the slave trade from a different perspective than the one presented on the opposite side of the Atlantic.
"The door of no return" through which slaves began their journey to the Americas
After a day in Cape Coast, I spent the night at a little backpackers on a nearby beach. Early the next morning, I walked down the beach, passing children and fishermen along the way.
I then headed north to Kakum National Rainforest for a canopy walk through the forest.
After visiting Kakum, lunch was at a nearby restaurant, which is set in the middle of a pond filled with crocodiles. Weird, I know, and kind of terrifying, but kind of cool at the same time.

October: Switzerland

In October, I met a friend in Switzerland and spent a long weekend in and around Geneva. It was a perfect escape from Egypt!

November: Rwanda

November saw what has become an annual return to Rwanda for Thanksgiving and, this time, to show some friends around the country I used to call home. I spent a week traveling around the country and catching up with old friends over good times like Thanksgiving dinner and moto polo.

December: Egypt & Israel

At the end of the year, I was able to take some time to travel when my mom and brother came to visit for two weeks. We spent most of our time in Egypt, visiting some of the most impressive sites in Cairo and Luxor, and were also able to spend a few days in Israel, relaxing at the Dead Sea and seeing Jerusalem and Bethlehem. It was a wonderful, wonderful time!

And that pretty much sums up my travels at the end of 2009. I'll try to be a little better about keeping up with the blog in 2010!

07 September 2009

New HIV vaccine target

About a month ago, I posted about an article that had been published from some research I worked on Bangladesh. Just last week, an article was published in Science about some exciting results from one of the vaccine studies we were doing in Rwanda. The study was sponsored by the International AIDS Vaccine Initiative (IAVI) and took place at sites around the world including the U.S., the U.K., Australia, and west, east and southern Africa. At our site, we identified and collected samples from individuals who had been infected with HIV for at least three years but who were clinically well and had never been on antiretroviral therapy (ART). Samples from all sites were sent to international laboratories, where two powerful new broadly neutralizing antibodies against HIV were identified. Results also revealed a new vulnerable spot on the HIV virus that no previously-known antibodies have targeted, which is huge news for vaccine development!

After so many disappointments and so much negativity in the world of HIV vaccine research over the past couple years, it's really exciting to see some new developments. Read more here.

02 September 2009

Detained and deported

As much as Egypt parades itself as a free democracy, sometimes reality hits. Last night a good friend was returning to the country after a three-month vacation in England and the U.S. When he arrived at the airport, he was detained, questioned and eventually deported. Although no reason was ever stated, it is most likely that this treatment resulted from his participation several months ago in a peaceful march in protest of Egypt's treatment of Gaza. Read more about his story here.

01 September 2009

A day on the beach in Ada

We arrived in Ghana late Saturday night and, even though sleeping in the next day would have been nice, we made plans to get up early to celebrate the birthday of one of our American colleagues who’s based in Accra. She and her husband picked us up early that morning and we headed east to an area called Ada, which is about an hour away from Accra.

Our colleague is married to a Ghanaian who has a cousin who owns a little beach camp right where the Volta River meets the Atlantic Ocean, so we had planned to spend the day there. I knew having a day to relax outside Cairo would be nice, but I had no idea how beautiful and relaxing the area would be.
When we arrived in Ada, we hopped on a little boat on the shore of the Volta River and headed toward the Atlantic. When we were just a short way from the ocean, we pulled over to a little sandy strip of land (barely 100 metres wide) between the river and the ocean. This was our friend’s beach camp and it was perfect – bare bones cabins, empty hammocks and relative silence. We strolled over to the Atlantic and walked on the beach for a while. It was a beautiful day and the waves were powerful and majestic, but, as much as I wanted to, it was impossible to ignore the incredible amount of garbage on the beach. The beach was literally covered in garbage, not from tourists dropping their water bottles and candy wrappers, but from cities all along the West coast of Africa. Ghana, like so many other countries in the world, including the United States, uses the oceans of the world as a giant landfill, and Ada is one of the places where the local population is too poor to clean the beaches, so instead they are covered in garbage.
After walking along the beach, we decided to settle in and relax at the camp for a bit. A couple hours later, our colleague’s husband’s cousin took us out for a tour of the area by boat. I really had no idea how huge the Volta River actually is! Every time I thought we had reached the other side, our captain would turn the boat just so that I could realize that we were instead on the shore of another island.
After riding around for a while, admiring homes of foreign business men and sighing at the contrasting houses of the local population, we stopped on one of the islands. We had been discussing hopping off to walk through a village, so I assumed we had reached our destination, but I was very wrong.
Instead, we had reached one of the distilleries where local Ghanaians make their very own rum, with the claim that Jamaican rum is nothing compared to Ghanaian. (I might argue that “moonshine” would be a better term to describe what we saw and tasted, but “rum” is the local term.) Apparently the process goes something like this:

Step 1: Grind sugar cane through this antique contraption.
Step 2: Transfer the sugar cane juice to these giant pots to ferment.
Step 3: Pour fermented sugar cane juice into this barrel and light a fire underneath (after removing the baby goat, of course).
Step 3: Let the liquid boil and transfer through the coil from one barrel to the other.
Step 4: Let the liquid cool and drain into this glass container, being sure to release and discard the methanol first.
Then somehow the “rum” makes it from the glass container into recycled water bottles that sit for sale in this little store.
After “ooo-ing and “ahhh-ing” and asking questions at every stop during our tour, I thought we would return to the boat and continue our relaxing afternoon of cruising on the river. I was wrong. Apparently there’s no way to get off a rum maker’s island without first tasting his product.

We all sat down in the middle of the operation at a table, surrounded by curious children, baby goats and chickens, and a large bottle of “rum” appeared with a shot glass. (The rum maker thought it was hilarious that his shot glass said “Jamaica” and made several references to the fact that his rum was better than any from Jamaica but that he didn’t have a shot glass that said “Ghana”.) The rum maker began making his way around the table, serving each person a shot of rum. There was no opportunity to say no.

My colleague who had traveled with me from Cairo was up first and took her shot like a champ. I was up next. Now, I feel like I’m usually pretty good in these types of situations that involve eating or drinking something that might not necessarily be pleasant. This day I failed miserably. I swallowed down the shot in one gulp, and then I felt every organ from my tongue to my stomach burning. It was all I could do not to cough and cry. But I will say, had it not burned so badly, the flavor wasn’t bad. I’ll also say that the rum maker is some kind of salesman, because I still somehow walked away with a small water bottle as a souvenir.


After we’d all taken a couple obligatory shots of rum, we piled back into our little boat and took off into the river again. After a few minutes we spotted a fishing boat just coming in from the sea and unloading its cargo on the shore. The guys decided to buy some fish, so we stopped. It was an impressive operation. The fishermen stood on the boat unloading their fish into pans atop the heads of local women, who carried the fish to shore and unloaded them into neat stacks. Meanwhile children played in the water and climbed on the boat, and it didn’t take long to realize that they were stealing fish. Occasionally one would surface from under the water and take off running, with a huge grin across his face and a single fish in his hands.

With our load of fish, we took off on foot through the village, heading back up the Volta River toward the spot where we had left the car. We stopped for dinner and to watch the sunset and then headed back to Ghana. Not a bad day at all.