Nairobi!

I love Kisumu. I really do but the time had come to get out and get back to civilization. Not that Kisumu isn't civilized because come on it is the third largest city in Kenya. Mainly I was craving American food and a little shopping. My friend Rachel and I decided that a girl's weekend was in order and off we went. We were lucky enough to catch a ride to Nairobi with another friend and arrived Friday afternoon. Once there we indulged in some pizza and iced tea!!! (did I mention that I was craving American food?) We did a little window shopping as the big malls in Nairobi are a little out of my Kenyan price range. Eventually we ended up at this little market in a back stall going through bags and bags of clothes. I managed to get 10 things for 33 dollars!! A steal as they were all dresses. We stayed at this great place, kind of a back packers camp in the city. It was a family's home with tents in the backyard. It was a great oasis in the middle of the city!

The second day we took a cab to Karen which is a suburb of Nairobi and went to the Giraffe center. Again kind of a tourist trap but it was a lot of fun. We got to see about 6 giraffes up close and personal. They even let you feed them! As you can see from the picture it was an experience. Their tongues are quite rough and they slobber a lot. At the center we also did a short nature walk. We didn't see many animals but it was nice walk and had a good view at the end. Later that day we headed to the Masaii market. Its a huge market that rotates around Nairobi depending on the day. It has everything and was actually a bit overwhelming. I think we walked around it a few times before buying anything. It was off to indulge in some more non-Kenyan food for lunch and then back to the market for more shopping. On our way we found this great curio shop where I actually ended up getting a lot of my stuff. It was reasonably priced and the owner didn't hassle you to purchase. This is one of my least favorite things about the markets. The vendors come up to you and try to get you to look at their stuff and you end up getting pulled in five different directions. Needless to say I did some terrific bargaining. One vendor even told me to not tell the other 'mzungos' (white people) what I got him down too!

Later that night we went to see a movie, Eclipse. Was fun but the movie wasn't great so kind of a toss up on that. Our accommodation was great that night though as we got a garden tent and slept outside. You can see Rachel in the picture in our tent! Sunday was relaxing as we slept late and then headed back to Kisumu. The bus ride back was long (7 hours) and definitely was worse than the comfy ride we got there. Overall a nice break from Kisumu, but I can say that I love it here and wouldn't trade it for Nairobi any day!

The referendum

Kenya has a rocky political history. It was colonized by the British, then overthrew their rule to be led by numerous corrupt and unstable politicians. Most recently the 2007 election brought a major conflict among the Kenya people. After the election both candidates declared victory but only one was sworn in (the one the people DID NOT want). This flamed an ethnic war between the Kikuyu tribe and non-Kikuyu. The bulk of the conflict was centered on the Rift Valley and the Kisumu area with hundreds of homes and businesses destroyed and looted. By the time the UN intervened in 2008 over 1300 individuals had died as a direct result of the violence and more than half a million people were displaced. The Kenyan government was in shambles and the constitution was thrown out. Recently, however, Kenya has seen a time of peace and stability. This all may change come August 4th.

August 4th is the voting day for the new constitution. The new constitution has been in the works since the old one was thrown out back in 2008. It has gained a lot of publicity the last few months as both supporters and those opposed hold rallies across the country. For the most part, Kenyans are in favor of the new constitution. Those who are not are mainly the religious sectors who main opposition is the abortion clause. They claim it legalizes abortion when it really only gives a women the option if the pregnancy is threatening her life.

Here in Kisumu people are in favor, like the majority. As Kisumu has a reputation for rocky political clashes the sense is everything will be calm if the referendum passes. Currently the polls are 65% yes and 35% no. I don't want to worry anyone as it is highly unlikely that anything will happen. All American organizations are taking precautions as well. CDC is closed that entire week and I am on house arrest so to say. They aren't expecting anything but preparing none to less. My hope is one the voting occurs peacefully and fairly and two the constitution passes because it crucial for Kenya to have a strong democratic system in place to afford stability to its people. The picture is of a pro-constitution rally at my study site the other day (Lwak)!

So unusual I had to stop and take a picture

So you never see this in Kenya and I mean never, not even in Nairobi! Street lights. In KENYA!!! I didn't think it was real and my supervisor was so baffled that she stopped to make sure we weren't lost.

This past week my supervisor and I drove out to her family's country home to pick up her kids. The drive was rough but beautiful. Modern day road trip minus getting stuck behind a mule driven cart. Her family was so welcoming and nice. I have never been so nicely treated and fed! Her mom is an activist. She has an organization for widowed women and their families. She builds houses for them and starts programs that will generate income. Right now she is working on a garden and a fish pond. I wish I had half of this lady's drive! The compound was really nice with a few head of cattle and geese. The air was so clean and refreshing in the country I got a little bit of a sore throat. Bad when you start getting used to smog and pollution. I don't know if I will get back but it was definitely worth the day off and long car ride. Rachel's kids are so cute and I managed to get three pictures to put up on my walls thanks to Serabi and Steve! Sadly this is the only picture I took of the day trip..

Study Sites-Ong'ielo

So this is the second of the three sites, Ong'ielo. It is the second largest site we have and sees about 25% of the total patients daily. It has a long history of research as there is already a HIV CDC study on the ground and a GEM study (diarrhea). It is also a Ministry of Health run facility and like others very poorly understaffed. Surprisingly there is a lot of construction being done. A new maternal and child inpatient ward is being built along with offices. This is huge as Ong'ielo currently does not have any inpatient support.

Like Lwak, Ong'ielo is also a site for the seasonal influenza vaccine effectiveness study. Two nurses and one health facility recorder see approximately 20 kids a day ages 6 months to 10 years. The clinic has seen numbers as low as 10 and as high as 90.

Currently I am trying to get surveillance for respiratory illness off the ground here. It has proved challenging for many reasons. One it is hard to find participants as there are so many projects already on the ground. Two there is no free care. So if for instance a nurse says yes your child is ill and I recommend you get medication for him/her the parents must then pay for it at the dispensary (that is if they have the medication in stock). At Lwak this care is free. Lastly my staff....oh my staff. In general I love them. They are great people, very friendly, and open. I just don't know what it is with this site but its just chaotic, in general. So thus my surveillance tends to take a back burner. Maybe this week it'll turn around?

The pictures are of Ronald the health facility recorder at the site. He logs in the patients and takes their temperature. The second is of a group of kids who just thought my white skin was the coolest thing, that was until I took their picture.

Its a miracle

They came clean!!

I guess this would be a better picture if I had a before, but lets just say the white tennis shoes were black and had a slight mildew odor. Yeah the laundry women worked their miracles.

That's deadly....literally

This weekend I climbed a mountain or at least attempted to. Alone that presents a pretty interesting challenge. It was a hard climb with narrow trails plus the whole climbing altitude thing. But Mount Elgon proved to take this to another extreme.

Mount Elgon is in north west Kenya on the boarder between Kenya and Uganda. Actually the peak of the mountain lies in the Uganda side and with permission beforehand you can climb down into the country. It is an extinct volcano with very distinct wildlife and vegetation. The park itself is beautiful but has the nickname of the 'loneliest park' in Kenya. After visiting I can see why. The entire time we were there we did not encounter any other humans just wildlife and the park rangers!

The plan for the weekend was to camp in the park, hike the mountain, and explore some of the caves. Did we do all three.....I'd say about 1.5 things were accomplished on this list. The camping, no. And why did we not camp when both of our cars were loaded down with camping supplies? Because it rained, no poured, the entire weekend. This made camping very unappealing. You can see from the pictures that the rain caught most of my attention over the weekend.

The mountain. This qualifies as the 0.5 because yes we did climb. We did not make it to the top and some of us didn't even make it to the base camp (i.e. me). I blame this on many factors mainly the altitude and poorly marked trails. The trails were nonexistent. In fact there were many times where I just stopped and looked around hoping to find some kind of marker or footprint. I also managed to roll my ankles at least 50 times on the way up. Its wet up on the mountain and wet translates to potholes and mud. The combination will of course soak your pants and shoes. I was lucky. I managed to make it pretty far, turn around, and get to the car before the rain hit. Everyone else came back soaked.

Overall the hike was an experience. I'll have to say though the trip up the mountain is one I'll remember more though. Its a 30km drive up to the peak and then a 6km walk to the summit from there. 30km not bad right or so I thought. At the time I was just thankful that I wouldn't have to walk it. But it turned out to be 30 kms of hairpin turns and muddy ditches. There were times where we slid sideways both up and down the mountain! Which I didn't think was possible. There were times where figuring out how to cross a downed tree was necessary and of course we had to get out and push at one point. Sometimes I'm thankful for 4WD and a little prayer doesn't hurt either.

The one thing that I can definitely say we did was explore the caves. We went to Kitim cave which is famous from the book the Hot Zone where is is reported that two tourists visited the cave and then came down with Ebola, a very deadly virus. And yes we actually wanted to go visit this place! The hike was semi easy. Only about a mile of sink holes to avoid and a river to cross but the view was worth it. Both caves boasted waterfalls and a resident bat population. They didn't take kindly to us waking them up but it was an awesome site to see them take flight.

To cap off the weekend it poured the whole way home as well. Normally not a big deal in America right. Well Kenya roads aren't set up for monsoons surprisingly enough. Add in the already poor road between the park and Kisumu and its a recipe for disaster. Think rivers and lakes instead of roads and you have the gist. Again thank god for 4WD and an awesome driver! The fourth of July was definitely one to remember this year. Another adventure and great memories to go along with it!

Study Sites-Lwak

Ever since I started my project I have been meaning to do three posts on each of the test sites and am just now getting around to it. Lwak Hospital was originally started by a group of Catholic missionaries in Lwak. It is fairly large and the biggest of the three sites. It also has inpatient wards which both Mahaya and On'gielo lack. The hospital sees tons of patients a day most of which are IEIP study participants. IEIP is a branch of the CDC and they have a very large surveillance study on the ground here that tracks cases of malaria, diarrhea, influenza, etc. I mean its massive! Patients come in daily for routine check ups, consult with a nurse, are administered a quick survey, and then are sent for lab work. All for free! This is the best part of the system because it directly benefits the patient which doesn't always happen in research, at least directly. Since surveillance is already being done here (and very well) there is no need for me to start my project at the hospital. However, the seasonal influenza vaccine effectiveness study I was originally focused on is based here. Two nurses see approximately 50 patients a day (it can range from 30 to 100!). They confirm the patent's participation in the IEIP program, administer a survey, and then 'jab' the patient. It took me a full week to figure out that jab was the Kenyan way of saying vaccinate. The pictures above are of the clinic site. Hezron and Angiline take temperatures and get consent outside of the hospital. Patients are not allowed to be vaccinated if they currently have a temperature or have a history of temperature. This day I believe they saw a record of 98 patients at the clinic! Inside Irene and Carren administer the vaccine while Rael monitors the vaccine cool box. Without electricity at the sites the vaccines have to be carried out to the field in cooler boxes and checked frequently so that the vaccines stay within the correct temperature range. The last picture is of the little girl that was about to be vaccinated. My hope in taking her picture was to distract her while they did the jab....it didn't work.