Happenings

Photos from some recent fun things....

CHAI retreat.... we had a really good (and fun) overnight retreat in the Mabira rainforest a few weeks ago

Thanksgiving
I hosted a mini-Thanksgiving for 14 on the Saturday after Thanksgiving.  Menu: rustic zucchini and onion stuffing, green beans with goat cheese feta, mashed potatoes, pumpkin puree, cornbread, and apple crisp.  No turkey (and no cranberries as they don't grow them here), but very tasty.

One detail I forgot to mention (probably because it is sadly so normal here) is that the power went out at 6pm.... thankfully I had baked most things before then and we had plenty of gas, so we made do and had a nice candlelit dinner.

Going away Party
With an office full of expats, you get used to people coming and going fairly frequently.  We hosted a going away barbecue for 2 co-workers and a friend the weekend before last in my yard.

One of the girls leaving used to work for a refugee rights organization in which a band of refugees from an assortment of African countries had assembled -- they came and played for the party.

It has been really fun to have enough space to host people - I'm starting to build a repertoire of party foods.  Chief among these might be green bean salad, which is just blanched green beans, butter, white vinegar, and goat cheese feta.  It's very simple, but the goat cheese feta (made by Zach at the market I go to on Saturday mornings) is delicious, so it works really well.
One slightly bizarre, but really nice thing about hosting people here is that if it seems like too much to clean up after the party, we can hire someone to come do all the dishes and clean everything up for $5-10.  

Beautiful Eastern Uganda

I was in Eastern Uganda this week for more Pima trainings and had the pleasant surprise of seeing some amazing scenery (and really adorable twins).  The pictures are horrendous because they were taken from a moving car with an iPhone camera, but hopefully they capture some of it.

 Tororo Rock - I recognized this rock from the Tororo Cement advertisements that are all over the country

 Awful photo of gorgeous Mount Elgon

We visited a town half a kilometer from the Kenyan border called Busia that was possibly the busiest town I have ever been in.  The streets were bustling with people and full of bicyclists wearing pink uniforms, which made for kind of a neat visual.  I asked why there were so many bicycles and was told they were easier to sneak across the border than motorcycles!  The amount of life on display in the town made me think about the American idea of a busy city (I like this article about the role of public spaces in the creation of community in NY) and the relatively huge amount of American life that happens in isolated spaces (homes, cars) as compared to the way life spills into the streets and plazas here.

 And finally, really adorable twins....

Pima Trainings

One of my recent workstreams has been on creating a training package for introducing a new type of machine for CD4 testing into health centers.  CD4 testing allows HIV-positive patients to track the progression of their disease by determining how many of a certain type of white blood cell (CD4 cell) they have.  When patients dip below a certain level (350), they should initiate anti-retroviral therapy because their immune systems are too weak to fight off disease and they are at risk of developing opportunistic infections and are more likely to pass on the disease.

However, it can be really hard for patients to access these tests because of the limited number of testers in the country and long turnaround times for results, meaning patients are not getting the right treatment and are more likely to get lost.  The new type of machine (the Pima) allows patients to be tested in 20 minutes, is very easy to use, and can run on a battery for 8 hours (critical given current power situation).  We've been working on supporting the introduction of these machines and creating a training program for health centers on how to integrate the machine into their facility and make sure they are used to test as many patients as possible.  It's really interesting and I think very valuable given the importance of this test in treating patients.  We have already done the training of trainers, and now we are rolling out the training to facilities to see if it is effective.

As part of this work, I spent Monday and Tuesday this week overseeing a training 3.5 hours from Kampala in Kyegegwa.  The training went very well, and I'll be back there in a couple weeks to do mentorship and preliminary data collection.  As we were leaving, the health workers did a thank you dance for us called a "warm clap" - definitely a highlight.

Here's a NYTimes article explaining the benefits of introducing this machine.

Gorgeous morning drive to the health center

 The health care workers with the machine

 The "Warm Clap"

Fort Portal weekend

This weekend was yet another that made me pinch myself.... I spent it with a group of 8 friends in a beautiful lakeside lodge in Southwest Uganda, hiked to a gorgeous secluded waterfall where we were the only visitors, and went on an awesome hike and bike ride around the lakes.  Our hike was in pouring rain, but it was still gorgeous and a lot of fun, though swimming in the waterfall was probably the highlight of the day.  Also, our lodging bill for the whole weekend came to $25pp!  We saw baboons (they look like dogs when they are running) and loads of monkeys and some amazing birds.  

First (half) Ugandan wedding

I went to my first wedding here on Sunday - quite an experience.  The groom was a Serbian guy working here who I met through one of my co-workers and the bride was a lovely Ugandan woman.  The wedding crowd was about half Ugandan and half a mix of expats and Serbians -- a very entertaining combination of cultures.  There were quite a lot of (sometimes hilarious) speeches, gifts of goats and gourds and milk and whatnot, and good food and wedding fun.

PSAs in the Ugandan health sector

Most of the health-related PSAs I've seen here have made me do a double take.  Some are particularly memorable and really make you wonder what they could possibly accomplish.  Here is a small sample....

More pictures from last weekend

Rhinos!

I went to a rhino sanctuary this weekend for a short getaway with a big group from Kampala.  We drove up Saturday morning, had a wonderful lunch prepared by a few members of our group of 14, and then went for a rhino trek.  The sanctuary has 10 very well-guarded rhinos -- they need to be tracked and guarded because rhino horns sell for $50-100,000!  It was neat to see the rhinos on this huge sanctuary - two of them had actually been born at Animal Kingdom in Disney World, but were brought to Uganda to breed and re-introduce rhinos into the country after poaching killed them off by the 80s.  One of the rhinos is named Obama because his mom was born at Animal Kingdom in the US and his dad was born in Kenya.  

We had a lovely barbecue and campfire (plus spectacular stargazing) Saturday night, and then we went for a really cool bird watching canoe trip and hike through a swamp early Sunday morning.  I have to get photos of the hike from someone else because I forgot to charge my camera, but here are some rhino pictures and the beautiful Sunday sunrise.  

Life here.

A fake interview with me (questions inspired by real questions I've been asked):
Q: WOW what's it like driving on the wrong side of the road?
A: Easy!  The hard part is dealing with some crazy drivers and loads of motorcycles.  Thankfully cars move very slowly (I don't think I've driven >40mph here and usually slower), so you have more time to react.
Q: You're near the equator, so is it like 100 degrees all the time?
A: No!  The weather is awesome!  It's roughly 65-85 degrees year round, with rain being the only variable.  We are in the rainy season now, but the rain is usually only for an hour a day or less.  We have almost all of our internal meetings outdoors, eat outside all the time, and every time I walk outside at night, I feel like I'm on vacation.  It is definitely weird not feeling a change in seasons - it's hard to get the sense of time passing (and I miss fall colors and Michigan apples), but it's pretty great to be able to be outdoors year round and never have to bundle up. 
Q: Any weird surprises?

Hotpot night at a Chinese restaurant

A: Hm - I guess that my Chinese has come in way more handy than expected.  There are several good Chinese restaurants, and it's always best to order in Chinese, and casinos here tend to be filled with Chinese businessmen. I don't like to gamble, so when I've been to the casino with friends, my entertainment is finding a Chinese person to make friends with.  I usually get some funny stares, but I've gotten to learn a bit about Chinese companies operating in Uganda and life here for people who don't speak English.  I may never use it for work again, but I guess Chinese is a fun language to be able to speak. 
Q: Do you lose power a lot?
A: Yes.  Computing by candlelight as we speak.  It's frustrating and tough to get work done sometimes, but with a combination of generators, candles, and long battery life computers, we cope pretty well, though it's clearly a really bad thing for the country and has gotten way worse even since I moved here.  On the plus side, I never fully appreciated how awesome candles were until now. 

Work work work

Work has been a bit hectic lately (part of the reason for my terrible blogging), but it is hectic in a really good way.  One of the big projects I have been working on is really getting off the ground and another one is finally wrapping up.  I wrote a while back about our research on HIV care before patients begin antiretroviral therapy and how big an issue (54% of patients are lost!) patient retention is.  Along with Isaac and Evan, I've been working on developing an intervention to pilot to try to improve retention and quality of care.  We've been visiting health centers, meeting with people in all areas of HIV care, digging for research, and communicating with other CHAI offices to figure out what makes the most sense. 
After multiple iterations, the intervention we are going to pilot (in 7 sites - site visits next week!) is one that combines improving data management with introducing reminders and follow-ups.  We, along with a team from one of the PEPFAR implementing partners, are going to be working with sites to re-organize patient files and improve systems to make sure that files are not lost and that they are complete -- this is a big issue in treating HIV as a chronic disease because doctors need to know a patient's medical history in order to know how to treat them, and we frequently see patient records piled haphazardly in facilities.  The hope is that doing this will cut down the time staff spend digging for records, ensure that test results reach patients, and reduce the huge information loss that happens when patient files go missing.  The second piece is introducing text message reminders to remind patients when to come back to the clinic and implementing a system of phone call follow-ups for when patients miss their appointments.  Mobile phones are amazingly widespread (74% of patients had them in a recent CHAI study), and from the existing published research and work CHAI has done elsewhere, it seems like this is a way we can really improve attendance and retention.  In a recent CHAI pilot, patients were more than 50% more likely to come back when followed up by phone than otherwise.  
There's a bit more to it than that, but those are the basics, and I'm really excited about it!  The pilot should give us some very interesting information, and the Ministry of Health is interesting in rolling this system out more broadly in the country if the pilot goes well.  It's a very cool feeling to be working on something that I was a big part of developing and really believe can be effective.  Funding issues, getting sites to actually implement changes, and politics will all be uphill battles, but I think/hope that this can help bring patients back to get the care they so desperately need. 
(and let me know if you know of any relevant studies/research - have found a lot of great evidence on the usefulness of each of these elements, but always looking for more).

Ssese Islands

Last weekend, we went on a fellowship retreat on the Ssese Islands (in Lake Victoria) for all the Global Health Corps fellows based in Uganda.  It was a lot of fun and nice to have time to discuss what we have done so far and what our goals are for the rest of the year.  The islands are quiet, but really, really beautiful. We had a bonfire, ate good food, went swimming at night, and just enjoyed each other's company.

 Monkey friend!

 Isaac and crew running out of the rain

 View from where we were staying up on a hill

 The Uganda crew

The only bad part of the weekend was when I woke up on Saturday morning to discover that I had slept next to the below pile of mouse (we think) poop - SO GROSS!  It seems to have been hidden under the blanket and the bed hadn't been made for a long time.  Pretty horrifying.  The next night, my friend volunteered to sleep in the affected bed (the sheets had been changed), and I was very, very grateful.