I miss this

Even though I do love my vegetable stand in Cairo, I miss shopping at places like this...

Carolina for Kibera

One organization that's doing a lot of good work for health in Kibera is Carolina for Kibera, based out of the University of North Carolina. Although I'm not usually a fan of UNC (GO TIGERS AND BLUE DEVILS!), I can't not support their work here. It's pretty incredible. Visit their website here.

Kibera

If you want to talk about irony and injustice, consider my last 24 hours in Nairobi. I stayed at an incredibly nice hotel and then got up at 5:00 in the morning to go out into Kibera, the largest slum in Africa and home to over a million people. Visiting Kibera is a very different experience than visiting Kisumu. Together with the public health advisor for IEIP-Kenya, I was dropped off at the field office on the edge of Kibera. She and I then began to walk into the area, carrying nothing but a bottle of water, lest any cameras, money, phones or other valuables be spotted by someone around us. Kibera is not a place many foreigners who are not in some way associated with IEIP visit. At one point in time it wasn't even recommended that foreigners enter Kibera in the daylight and now, even with the enormous lights that hover over the informal settlement having been donated by Kenya's largest chain of supermarkets, some would call it suicide to try to visit Kibera at night.

Yet, even with all this history and various warnings, I was just as comfortable in Kibera as I am anywhere else. I loved squeezing through passageways between shacks and responding to children who shout out "Mzungu! How are you?" and respond with "I am fine" when you say "Hello!" (Somehow, I'm convinced, a huge portion of the population of anglophone East Africa has switched the meanings of "Hello!" and "How are you?") I was thrilled to walk through clinics and sit with doctors and nurses who work in what many would consider the worst of conditions to make sure that even the poorest receive health care and medication. It felt a lot like home.

IEIP-Kenya has a large project in Kibera that is very similar to their population-based surveillance project in Kisumu. The setting, obviously, is very different, but they still use community interviewers to visit households every two weeks and also collect data at two (soon to be three) clinics in the area. Perhaps the largest difference in the projects is that IEIP-Kenya runs the clinics in Kibera on their own; there are no government and only one or two private clinics in Kibera, so there are no partnerships to develop.

I went out with one of the community interviewers in Kibera and accompanied her to several households. It was extremely useful from a work perspective to see the study and data collection firsthand, but at the same time it was so, so much fun. I loved the people I met, albeit briefly, and had a great time chatting with them.

The following picture is my only one from the day, snapped quickly by IEIP-Kenya's public health advisor in one of the households in Kibera. A couple notes of interest: (1) The baby I'm holding was handed to me as soon as I walked in the door of this household, (2) If you look closely, you can see that the community interviewer next to me is holding a PDA (Personal Data Assistant), which is a cross between a phone and a laptop that's being used to administer the surveillance questionnaire (I'll write more on this later, but it's a really cool advancement in the world of research ), and (3) That sign behind us that says (ESIDANT) is a campaign poster for Barack Obama. I love it!

Safari Park Hotel

The guy who is responsible for making my travel arrangements at NAMRU-3 messes them up all the time. Usually it's really frustrating - he books the wrong flight, forgets to get clearance from the U.S. Embassy, buys two travel insurance policies - but this time, I was ok with it!

After my time in Kisumu, I came back to Nairobi to visit the IEIP site here. I found out less than a couple hours before my plane left from Kisumu that the hotel in which I was booked to stay was not on the list of hotels that are approved by the U.S. Embassy. Since I was already at the airport, I had to scramble to make phone calls back to Cairo to try to figure out what I needed to do, whether I needed to change hotels or if I could stay at the same one. I was scrambling, and apparently several people back at NAMRU-3 were too, but finally they sent me the name of a hotel and told me I had a reservation. As it turns out, they had a really difficult time finding a hotel for me because there were several trainings and conferences going on in Nairobi at the same time. The hotel they finally found that both had an empty room and was approved by the U.S. Embassy was called the Safari Park Hotel.

I think it's the only time I've been thankful for an error in travel arrangements! The hotel was absolutely beautiful and so much nicer than anywhere else I would have stayed. I actually found myself silently thanking the travel office for their error, the U.S. Embassy for their strict (if ridiculous) hotel standards and the hotel for the discounts they give to people traveling on official government business!

KIS

This is, by far, my favorite airport ever. Between the beautiful Kenyan skies, the open green land, the unique waiting area (that would be the tent with the gray roof on the left side of the following picture) and the airport control tower that looks more like an abandoned old house, you just can't beat it!

"Obama's home"

"Do you want to go to Obama's home?" "I can take you to Obama's house." "Did you come here to visit Obama's family?" "Have you seen Obama's village?"

Every conversation I've had with a taxi driver in Kisumu begins with one of these questions. Taxi drivers here love Barack Obama. In fact, I think everyone here loves Barack Obama. Maybe even more than the rest of Kenya, because Barack Obama's family is indeed from Kisumu. His ancestral home is only a few kilometers outside Kisumu and today I passed the road that leads to "his" house. Every taxi driver wanted to take me there. Unfortunately, though, I ran out of time to pay a visit.

Lake Victoria

I remember looking at maps of Africa when I was a child and there was only ever one thing on the map that stood out to me. A blue dot right in the middle of the continent - Lake Victoria. I had to visit it. (For those of you who are completely missing the point of this story, my middle name, which I happen to like a lot, is Victoria.) Anyway, Lake Victoria was the only place I ever saw on a map when I was young that made me think, "Wow. I have to go there."

Well, now I've finally made it! And I'm thrilled! The lake is just as beautiful as I imagined as a child. Unfortunately, the only picture I took is blurry and distant.

Culture shock

Surprisingly, I had a little bit of culture shock when I arrived in Kenya. I'm sure it started with the random strangers from the plane/hotel who invited me to dinner, but it was definitely continued today with my visit to IEIP-Kenya and its field site in Kisumu.

When I was leaving my hotel this morning to go to the IEIP-Kenya office, I hopped in the front seat of a taxi and spent the entire ride chatting with the taxi driver. Although this was common practice in Rwanda and other east African countries, it's something I would NEVER do in Egypt.

Once I was at the IEIP-Kenya office, when we were about to leave to go out to the field site (almost an hour away) everyone got in the car and I realized I was sitting in the middle of the backseat in a car with four men. Again, although it was something with which I was completely comfortable, it was something I would NEVER do in Egypt.

About halfway through the day, two of othe men from IEIP offered to take me to lunch. We went to a place that was little more than a shack, with bedsheets hanging on the wall as curtains to cover the walls made of sheet metal and scraps of wood, and an assortment of plastic lawn furniture inside. Chickens and children and dogs wandered around us while we at a lunch of fresh fried tilapia, ugali (similar to a hunk of cold grits) and kachumbari (almost like salsa). I absolutely loved it, but, again, eating lunch with two men who, until that morning, were strangers is something I would NEVER do in Egypt.

Although I loved everything on this list, I was surprised with myself at how accustomed I've become to life in Cairo and how unusual that made all of these things feel.

Kisumu field site

The IEIP-Kenya field site in Kisumu is impressive. The project has renovated a government training facility and made it its field office. Each building is an office for a different IEIP research or surveillance project. The main project is an active population-based surveillance study for severe acute respiratory illness, diarrheal disease, acute febrile illness and jaundice. In practical terms, that means that community interviewers go out into the community every day with a list of households they are assigned to visit. The lists are designed so that each household is visited once a week. During each visit, the community interviewers ask the head of the household questions about the health of each member of the household - whether they experienced any symptoms of illness, whether they were taken to a health care facility, etc.

In addition to collecting data at the household level, data are collected the health care facility in Lwak. St. Elizabeth's Hospital is a private hospital with which IEIP has partnered. IEIP has helped expand and remodel the facility and now provides some staff to assist the sisters who run the hospital. All community members who are enrolled in the household surveillance project receive free health care at the hospital, though other members of the community are able to seek care at the hospital as well. The data collected here are later linked to the household data to try to provide a complete picture of disease circulation and etiologies in the community.

Arrival in Kisumu

Nairobi wasn't my initial destination, though; my first real stop was Kisumu, in western Kenya. So after a full day's layover in Nairobi, I hopped on another small plane.

I had noticed the couple (who aren't actually a couple, just a guy and a girl who work together) when boarding in Nairobi. As it turns out, they were staying at the same hotel I was in Kisumu. We met at check-in and they immediately invited me to join them for dinner. I was thrilled.

Both live in Nairobi and have spent time in Kisumu before, so we drove to a place that apparently has good food and cold beer. This place was a typical east African hangout. A paved area between a supermarket and its parking lot, covered with a large tent and scattered with plastic lawn chairs and tables. Typical. And amazing. I immediately felt at home. We ordered a round of beers and started chatting right away. Before long, we decided to order dinner and soon we each had a huge plate with a whole tilapia, cole slaw and chips (fries, for you Americans). I felt even more at home. A DJ was playing awful east African hip hop in the background. The air was so thick and humid that we were all sweating, and I was thankful I had put on some Jungle Juice to keep the mosquitoes away. It was great.

Back in Nairobi

I've always thought Nairobi was a huge city, an enormous, congested place where I would never want to live. This time was different. After a few months in Cairo, Nairobi almost felt like a small town (other than the traffic, of course).

IEIP Kenya

I think I've mentioned before that there are several IEIP sites around the world. I probably said there were five, maybe six, but the number continues to grown. Right now, there are sites in Thailand, Kenya, Guatemala, China, Egypt, Bangladesh and Kazakhstan, but the number of sites keeps growing, so right now Egypt is sitting right about in the middle in terms of development and progress.

The site in Kenya has been running since 2004 and is much more well-established than our newer site in Egypt. There are activities ongoing in Nairobi, the capital and largest city in Kenya, and Kisumu, the third largest city in the country, located in the west on Lake Victoria.

IEIP-Kenya is far ahead of our site in terms of data collection in management, so I went down to visit the site for a few days and see the systems that they use and try to learn how we can implement similar systems in Cairo.
(I don't think I can even describe how jealous I am of the wide-open, green campus where their offices are located! So much nicer than our little plot of land in the middle of the city!)

Brilliant Kenya Airways

Another example of the brilliance of Kenya Airways...

Check-in guy: "Do you have any bags to check?"
Me: "No."
Check-in guy: "Any carry on?"
Me: (motioning to my small rolling suitcase) "Yes."
Check-in guy: "Can you weigh it please?"
Me: (thinking "Is he serious?" but still placing my bag on the scale) "Ok."
Me: (waiting....)
Check-in guy: "12 kilos. It is over the limit."
Me: (switching into argumentative mode) "But I always carry this bag!"
Check-in guy: "But Kenya Airways has strict regulations."
Me: "But I have carried heavier bags on the same flight."
Check-in guy: "Maybe if it were 10 kilos, but 12 is too much."
Me: "So what do you want me to do?"
Check-in guy: "You must remove something."
Me: "Umm..."

So I took my bag off the scale, opened it and pulled out the heaviest things I could think of - my portfolio and notebook, various electronics, my power converter (which is oddly heavy) - and put them in my large blue bag that I was carrying as my "personal item". I then placed the bag back on the scale. Check-in guy didn't look impressed with the new weight but said it was enough and I could take the bag on the plane.

I took my bag off the scale, walked 50 feet to the nearest bench, removed the items that I had transferred to my blue bag and repacked them in my rolling carry-on bag.

So what was the point of all of that!? If there is a weight limit on the bags because of some sort of airline regulation about the weight allowed on the plane, then that just doesn't make sense! I still had the same amount of weight; it was just distributed differently and I was able to redistribute it according to my preferences immediately afterwards.

There are some things about Kenya Airways that I will never understand. (Other things include their inability to depart on time or keep up with checked luggage.)

Panari Hotel

Last night I stayed at the Panari Hotel in Nairobi since my flight from Kigali arrived just after 4:00 in the afternoon and my flight to Lusaka didn't leave until 8:30 the next morning. There are only two words to describe this hotel:

1. Tacky: This must be the tackiest hotel in the world. I’m not exaggerating. There’s no other way to say it. Gold, glitter, mirrors, fake flowers, gold, glitter, mirrors, furniture that was modern in 1980, gold, glitter, mirrors, flower petals in the tables, gold, glitter, mirrors, ridiculous light fixtures, gold, glitter, mirrors...you get the idea. I actually laughed out loud when I arrived in my room. The pictures don't nearly do it justice.
2. Incredible: This description may be best understood by my friends in Kigali, but despite the decor, the hotel was simply incredible. I arrived and was checked in within less than 10 minutes. I then arrived in my room where I found a real bed with a real mattress (plus a down comforter and four pillows that actually had some substance to them!), a television (with CNN!), a bathroom with tile and hot water (and nice towels!) and even an air conditioner (that I could control!). It was amazing. When I found finally tear myself away from CNN, I went downstairs to dinner, which was a buffet that was absolutely delicious (cucumber soup, salad, numerous entrees, dessert with real chocolate syrup and whipped cream!) and accompanied by incredible service. After dinner and a hot shower, I crawled in bed for the night, managed to find a good movie that I'd never seen before on the television and fell asleep feeling like I was in a totally different world. (Note: If none of this makes any sense, it's probably because you've never spent an extended period of time in Rwanda.)

Adventures in NBO

Today I am sure I broke several airline and airport safety regulations. I thought things were going smoothly as I disembarked from my plane upon arrival in Nairobi. I had no trouble getting through passport control or obtaining a visa. As I approached baggage claim, both of my bags were just coming around the carousel and neither appeared to have been opened. I then exited the airport and began to scan the crowd of drivers and taxis holding up signs with names on them. I walked from one end of the giant crowd to the other, listening to offers of “taxi?” and “where are you going?” and “which hotel?” And yet I never saw a sign with my name. It would be a replay, I thought, of my last visit to Nairobi, during which the hotel forgot to send a driver to pick me up at the airport. Except this time, since I hadn’t made the travel arrangements myself, I didn’t even know the name of the hotel where I was staying, so I wouldn’t be able to take a taxi on my own to get there.

Thank goodness my Rwandan cell phone works in all of east Africa. I called one coworker from Kigali, who quickly sent a text back that she was in a meeting; I called another coworker, who sent back a text that she was in the same meeting; finally I spoke with a third coworker. She agreed to call the travel agency and then call me back. As it turns out, the hotel reservation was being made by Kenya Airways, not separately by the travel agency, so I needed only to contact Kenya Airways.

The only trouble was that the Kenya Airways office was back inside the airport, which I had just exited, so I broke my first safety regulation. I went back into the airport without going through any security, showing any identification or doing anything else one might expect. When I arrived at the hotel reservations desk, I was informed that I had to actually check in for my flight (which didn’t leave for 14 hours) before I could go to my hotel. Checking in meant breaking another regulation. I had to go backwards through the visa counter and passport control. Without showing any identification, I passed through, explaining that I had to check in for my flight so I could stay overnight. Since the regular airline counter was quite far, I decided to try my luck in the business-class lounge (no, I was not traveling business-class). So I walked straight in, tried to hide the awe on my face at the sight of wine and fresh fruit and various other snacks, and checked in for my flight. Then it was back through the visa counter and passport control (again without showing any identification or a ticket or anything at all), back to the hotel reservations desk and finally I was ready to go to my hotel.

The challenge ahead

On my flight from Amsterdam to Nairobi, I sat in the window seat next to two Kenyan businessmen living in the U.S. They were returning to Nairobi so that one could run for a seat in the senate. (I still don’t quite understand, but that’s not the point of my story.) While we were talking over dinner, I explained that I was in Africa to work in HIV research, and one of the men began to tell me about a book he read that explains the origin of AIDS. He told me all about the lab in California that created the disease, the men who came to Africa to test it on monkeys and those who later began testing it on humans. I was shocked. How could these men – these well-educated men who have lived abroad for over twenty years – believe such a myth? I of course did my best to explain to them the true origin of HIV/AIDS, but I don’t know that either of them was convinced. I’m sure they still believe the disease was invented by a group of scientists in California. The previously light conversation turned into a serious reality check for me. It was a reminder of the challenges to come working with a disease that is so seriously misunderstood.

The misconceptions and myths surrounding HIV/AIDS are almost endless. Some, such as the idea that HIV/AIDS in Africa is a conspiracy from the U.S. government or that having sex with a virgin can cure HIV/AIDS, seem almost absurd. It's easy to blame these misunderstandings on a lack of education or a lack of understanding. But the myths surrounding HIV/AIDS are just as common in developed countries like the U.S. as they are anywhere else in the world. Check out http://www.amsa.org/global/aids/aidsfacts.cfm for a summary of ten common myths from the perspective of the developed world.

A smooth trip

Any time you travel more than twenty-four (or in this case, more than forty-eight) hours around the world, there's at least one story that comes from the trip.

As I was checking in for my flight from GSP, I handed the woman at the Delta counter my passport. She quickly flipped through it, then looked up at me and said, “I need to see your current visa,” to which I of course replied, “Rwanda does not require a visa.” As it turns out, she was referring to Kenya, where I was scheduled for an overnight layover and which does in fact require a visa. Now I'm sure I checked this at some point (since I never applied for a visa, I’m sure whatever I found said I didn’t need one), but I’m also sure it was long enough ago that I couldn’t remember the details of what I found. Could they have changed the rules? Or did I somehow check the wrong country? Hiding the fact that I was in a slight panic, I gave the most logical answer I could to this woman who was set on not allowing me to leave GSP without a valid visa for Kenya – “I’ll just stay in the airport.” Spending 16 hours in the Nairobi airport was certainly not at the top of my list of things to do on this trip, but so long as I didn’t leave the airport, I didn’t need a visa, so I thought this might convince her to let me get on the plane. I think she was so confused by my slightly-absurd suggestion that she started looking for an alternative option and finally decided I could get a visa upon arrival at the airport.

Of course I couldn’t get off to a smooth start quite yet, so I had to try to get myself in trouble while going through security. Just remember, “Careful, it might explode” is not the right phrase to use when trying to warn the security guard that clothes, Kleenex, pens, gum, books, earphones, and who knows what else are liable to go flying in every direction while he searches your bag. Thankfully he knew what I meant (probably even before I started backtracking) and didn’t suspect me of being a terrorist. I have to admit, though, I did have flashes of having to call my mom on the other side of security to have her bail me out of the airport jail.

I finally boarded for Atlanta and fell asleep immediately, waking up just in time for my five-hour layover at ATL. Thankfully two friends came to entertain me while I waited, which made the time pass much more quickly. Before I knew it, I was going back through security (which was smooth this time, no bag searches or mention of explosions) to get on another flight. Then, after two movies, half a book, two crossword puzzles and a couple hours of sleep, I arrived in Amsterdam. With an airport full of smokers and an airline that makes you run from one end of the airport to the other to check in, only to run all the way back to the gate right next to the one where you arrived, I actually looked forward to getting on the next flight. Round three of security was also smooth, and eight hours later I was in Nairobi, where it only took about five minutes and twenty U.S. dollars to get a visa.

I spent the night in a hotel, and it felt so nice to take a shower (rather than splashing my face with cold water in the airplane bathroom) and sleep in a real bed (rather than twisting into some semi-comfortable position to sleep for a few minutes until the next snack cart came by). I left for the airport early the next morning to avoid Nairobi traffic and flew from Nairobi (where round four of security was a breeze) to Bujumbura. Then it was only a 40 minute flight to Kigali.

Finally, I made it.