Work = One More Week

It seems a little unreal to me that as I write this I only have one more week left at work.  As I have mentioned numerous times, my contract with KEMRI/CDC-Kenya expires at the end of this month.  With the Christmas holidays around the corner it seems that the end date has crept up even more.  The holidays have made the day to day around the office quite slow but I have still managed to finish up a few large projects.  My main goal was to complete one final year end report which I am still waiting on the data team to deliver.  I am also really excited to have completed the IRB renewal paperwork for next year.  All that's left is to submit it and hope the ERC is a bit faster than they were last year.

Next week I am hoping to get out to the field one last time.  However a nurses strike is paralyzing the medical system in Kenya and its likely the hospital will close before the end of the week.  From there its just a countdown till the end.

I am so thankful to have this experience.  I never thought in my wildest dream that CDC would allow me to come back yet alone start this project from the ground up.  I have learned so many lessons in management, study design and analysis.  I cannot express how grateful I am for the challenge!  I know that this experience is going to serve me well as I move forward with my career and am excited for what the future holds.

Thank you KEMRI/CDC-Kenya for two amazing years!

Work-the Wind Down

It seems a little surreal to me that I started this job almost a year and a half ago.  I was fresh out of graduate school and ready to get started on my own project.  I really didn't have any background on encephalitis but was very interested in this ground breaking study.  Encephalitis and the causes of it really hadn't been looked at in Kenya.  Everyone was focusing on malaria, TB and HIV.

I can't say it hasn't been challenging at times, but I think that every good job should be.  There should be times where your knowledge base is pushed and you emerge as a better leader and more informed in the end.  This project definitely saw those times as we struggled to get off the ground at Siaya and now as we try to expand to Mbagathi.  But we're still pushing and we'll get there.

With only one more month in the office (technically two but with holidays and the weddings its going to cut that time in half!), I can only look back and be thankful for the opportunity.  Its been such a blessing to be able to come back to a country I love and work for one of the world's leading public health organizations.  You can't get much better for a first job!

It'll be sad to go at the end of the year but I know I am leaving the project in capable hands.  I am excited to see the end results and wish I could work with the data myself.  All the staff at the office have been amazing and are such dear friends.  I can't imagine not seeing them on a daily basis.  But every opportunity in life is a stepping stone and this one is only going to lead to bigger and better things!

A Work Update

I realize that I don't write a lot about my work here on the blog.  Its not that I don't like what I do or don't find it interesting.  Its more that it has become the everyday to me and doesn't seem like the most relevant thing to update you on.  Recently we have begun taking steps to expand our project to another hospital in Kenya.  This time we are headed to a more urban site near our headquarters in Nairobi.

I have been busy coordinating with MOH staff at the hospital and hiring personnel to staff the project.  Recently I went to Nairobi to meet with hospital staff and also to take our lab chief to visit the hospital.  Our main goal was to get an idea of the feasibility of the MOH lab to perform the necessary tests and then to speak to the medical supervisor about the timeline for roll out of the project.  As most things go here, our plans were altered slightly and we were only able to tour the lab.

In the end it was probably best that we didn't get to speak to the medical supervisor.  Our visit to the lab raised questions that we didn't have the answers too.  I think its probably best that we take a step back and find these answers before moving forward with the staff.  Overall it will make the transition smoother.

So in the meantime, I'm waiting.  Waiting on data to come in from the data team so I can finish the third quarter report.  Waiting on the new study coordinator to start next week so I can begin to show her what I do on a day to day basis.  Waiting on the programming team to set up the new module on the netbooks so we can collect data at Mbagathi.  Waiting on HR to make decisions about new staff.  Waiting on procurement to obtain the new computers.

I understand the time needed to complete these tasks.  I really do, but I am concerned with the overall timing.  Its late September.  I will be in the states pretty much the entire month of November and December, well nothing really gets done in Kenya in December.  All of a sudden its the end of the year and my contract is over.  I have faith that I am leaving it in capable hands but that doesn't stop me from wanting to see this expansion finished before I leave.

So I will keep pushing.  Keep being that annoying American who keeps popping in day in and day out asking, "Is it done yet?"

Nairobi for the weekend

Earlier this week I flew to Nairobi for work.  In the next few months we hope to expand our project to another hospital in the city and I needed to meet with some key collaborators.  Overall our meetings went all right and we were able to take a few steps forward in terms of being ready to start.

mmmmm I love hot chocolate on a chilly Nairobi morning

Long before I set up meetings for work, I had planned on visiting Nairobi this weekend to spend some time with a good friend.  Rachel was my supervisor back when I was working on my masters thesis in 2010.  We had kept in touch over the years and have become really close.  I was excited to spend some time with her and her family.  She had also planned a trip to the spa to celebrate our engagement and enjoy some relaxation.

It was great!  We were able to spend a lot of time catching up.  I also got to go with her to her daughter, Serabi's play.  I had a blast chasing after her youngest as he took his first steps.  The spa was amazing as well.  We started out with a full body scrub, followed by some time in the steam room, and finally back for a full-body massage.  Talk about relaxing!  I definitely needed it.

Serabi as Mrs. Vain

Stephen, notice he's the only one who can't keep still

Cutie Shaun

Overall time in Nairobi is precious and usually much needed.  I got to enjoy great food and some quality time with a dear friend.  Hopefully next time it won't take me so long to get back!

3 more days....

3 MORE DAYS TILL THE USA!!

I can't believe I leave for the US in 3 days.  What seemed like a long count down is finally on the verge of occurring.  As usual, its a sprint to the finish.  I thought for the first time I would be able to leave with things running smoothly on the work front.  Now I am trying frantically to finish up loose ends: tracking down supplies for my staff, getting questionnaires printed, responding to scientific steering communities and finishing a biannual report.  

Here's a glimpse of my to do list at work:

1. Get gloves out of the store

2. Have data team print lab forms

3. Get adult data from the data team

4. Run SAS code on all data

5. Generate biannual report

6. Respond to ERC regarding protocol

7. Buy Glucose strips

It kills me how things get pushed to the back burner until they are absolutely necessary.  I don't work well in pressure situations.  I don't like procrastination.  Unfortunately my life is consumed by this.  Some how it will all get done.  It always does.  In the meantime I am praying for some peace before I leave and time to enjoy my vacation, family and friends. 

The Work: An Update

I realize that I don't write a lot about my work on this blog.  Its not because I don't love what I do but because it has become the everyday for me.  I get up, go to work and complete whatever projects/tasks I have laid out for myself.  But since I know this blog will become a sort of diary of our time here in Kenya, I feel I better give an update on my project.

I am currently coordinating an encephalitis surveillance study based in Siaya District Hospital in Siaya, Kenya.    We enroll all patients over the age of 6 weeks that exhibit a certain set of encephalitis-like symptoms.  From there we collect cerebral spinal fluid and blood to test for pathogens that may be making the patient sick.  Over the course of the patient's hospital stay, we collect more blood samples and monitor their overall progress.  We finally ask the patients to return to the hospital a month after their discharge for a follow-up visit to check their overall health and take yet another blood sample.

The main focus of this project is to see what is causing encephalitis in western Kenya.  Currently there isn't a lot of research out there on the subject and a lot of the hospitals in the area aren't even doing spinal taps on their patients!

The last six months of the project has had their ups and downs but I am happy to say things have been running smoothly as of late.  Some of our accomplishments in the last 6 months include:
1. Teaching medical students and interns the proper way to perform a spinal tap even with limited resources and supplies
2. Making spinal taps available to current MOH doctors.  They love that we do this service now and regularly request them for their patients!
3. Diagnosis our patients and being able to correctly administer the right antibiotics.  There's a lot of drug resistance here and finding out what is causing the infection goes a long way in helping treat it.
4. Changing the negative perceptions of spinal taps in the hospital and community
5. Successfully enrolling 85 patients and only have one person tell us no

We're also looking forward to expanding to Mbagathi District Hospital in Nairobi.  This urban site will give us some insight as to if there is any differences between encephalitis in the rural and urban areas.  Next week I will be meeting with key officers at the hospital to get some insight as to the best way to implement our project there.

So there it is, a short update on my project thus far.  Its been great working with CDC this past year and I am looking forward to finishing out the year with the group.  I'm hoping in my last six months here I can see the roll out of the new study site, the implementation of the new laboratory testing cards and the hiring of new study personnel.  But as all things in Kenya, these take time.  We'll see if 6 months is enough! :)

We're finally starting!

For those of you who are lucky enough to not know my frustrations with my current project, its been trying to say the least.  But fingers crossed, I think most of that is behind us now.  Guess I should provide a little background....

When I first arrived in June, I was welcomed to absolutely nothing.  I had originally thought that the project would be up and running with me just stepping in and running the field operations.  I quickly learned that I would be taking a larger role and that it was up to me to get things off the ground so to speak. 

The following months were the epitome of two steps forward and one step back.  There was weeks where so much progress was made that it seemed like there was no way we wouldn't be starting soon.  Then of course something would come along and push us back a few weeks to a month.  August turned to September then October and alas its November. 

This last month has been the worse with struggles to obtain supplies and paperwork, that in my opinion, was completely unnecessary.  The last hurdle was cleared today as I sat for 2 hours in the procurement office waiting for my lumbar needles.  They were delivered on Monday but alas were some how lost in the office.  "No I won't come back later.  Yes it is necessary that we have spinal tap needles for a study on spinal taps.  I'll just sit myself right here and wait until you find them.  Thank you."  (I don't think they like me much in the office)   Thankfully after some digging they emerged with my needles. 

Even with all the supplies and everyone ready to go I am still worried we won't start tomorrow.  I won't utter the words "what else could go wrong" but that's not keeping me from thinking it.   I understand there will be bumps along the road as we proceed forward but before that can happen we have to proceed forward.  

So here's to me on my way to Siaya tomorrow with a truck of supplies ready to start......fingers crossed.

My project

So I just realized the other day that I was only writing about my travels/adventures here in Kenya and wasn't writing about what I was actually doing here.  Yes I am working.  Yes I do put in an 8 hour work day (most days). 

I am currently coordinating an encephalitis surveillance project in Siaya (about an hour and a half from Kisumu) looking at the etiologies of encephalitis present here in Kenya.  We are using the already established surveillance team at Siaya hospital to identify cases of encephalitis and meningitis. Then administering a questionnaire to collect clinical information as well as some epidemiological data. 

From there our clinicians will step in and perform lumbar punctures (spinal taps) to collect cerebral spinal fluid.  The lab will then test the fluid for a large range of pathogens and hopefully we will get a hit on something.  Although I have no experience in the lab field, it has been interesting to learn a little about the technologies available there.  Everything has a price, but the what they can do in the lab now is pretty awesome. 

It has been an interesting road and has definitely been filled with its ups and downs.  What was supposed to start in June may just get going by early November.  Its just another testament to how long it takes for things to get moving here. 

Despite its challenges, the project has been interesting from the start.  Its a completely new field here yet there is so much burden in the field. I have found it much more rewarding to focus on the neglected diseases while here instead of the ones everyone is so familiar with (HIV, malaria, TB, etc.)

U.S. Secretary of Health pays CDC-Kenya a Visit

It was a pretty normal workday except for one tiny detail. The U.S. Secretary of Health was paying CDC-Kenya a visit. Now to the everyday folk this may not seem like such a big deal, but for the CDC campus here in Kenya to receive a visit you have to be doing SOMETHING right!

A few weeks earlier we had received word that she would be coming for a day to tour some of the facilities and sit in on some of the ongoing projects. She would also stop by campus in the evening to speak briefly to the staff. Immediately renovations were underway! The downstairs entry got a face lift as well as all four of the on site bathrooms. Now I can't say to what extent these changes were noticed but I know the staff here are grateful for the excuse to renovate. On top of construction changes the grounds were perked up a bit to get the place ready.

The day started to get interesting when we were informed at about noon of a lock down. All personnel were to remain inside of Kisian unless they did not want to return. At about 3:30pm all work stopped and the entire staff was ushered outside under tents to wait for her arrival. The doors were closed at 4:15 and no one was allowed to leave after this. Typical Kenyan time, the delegation arrived about 45 minutes late. I was actually surprised because I honestly thought they would not make it at all (the secretary had to catch a plane at 6:30pm).

After a few introductions, the U.S. Secretary of Health, Kathleen Sebelius, spoke briefly to the group. She talked about our achievements and the progress we've made thus far. She was adamant about the importance of future collaborations between the U.S. and Kenya and stressed the global nature of the work we were doing.

Overall, it was a nice afternoon. Do I think her visit changed my thoughts on public health or affected the work done here at CDC in any way? No. But I do think it was a good reminder of the importance of the government's role in our work. And its kind of cool to say I got to see her too! :)

Photos courtesy of CDC-Kenya

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.

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.

Switching projects

As many of you may know for the past three weeks I have been working on a seasonal influenza effectiveness study in the Kisumu area. We were vaccinating children ages 6 months to 10 years and then looking at the rates of respiratory illness over the next three years. Well this has been going ok. I was given some work but one of my colleagues was a bit reluctant to hand over any of her responsibilities as the primary investigator on the project had requested. So basically I was making copies and observing the field. Its a long story and not one I want to get into here. Not terribly exciting. Just this week though another investigator on the projected came and visited the sites with me. She noticed that I really don't have a job to do and suggested we look into doing something else. The team has been wanting to start influenza surveillance at two of the vaccine test sites for some time now but it really hasn't gotten off the ground really because they haven't had anyone to spear head it. So now that's me! I'll be coordinating the seasonal influenza surveillance at Ong'ielo and Mahaya dispensaries hopefully starting sometime this upcoming week. I'm really excited because its a lot more responsibility and its my own project. Right now I'm currently working out the logistics and confirming with the staff. Last week I was able to observe at Lwak where they already do influenza surveillance. It gave me a good idea of what to expect and how we want to run things. Pictures to come of the test sites!